If you look at where we are today vis-a-vis where we were 40 years ago in health care overall,

如果把今天的整体医疗水平和40年前的进行比较

it's a phenomenal success story.

就会发现它是一项巨大的成功

We've added 35 years to life in the last 100 years,

在过去的100年间 我们让人均寿命延长了35年

a combination of public health and medical advancement.

这是公共医疗和医学进步的共同结果

But because we have done so well in keeping you alive a long time, we've increased the cost.

但因为我们在延长寿命方面做得太过出色 存活成本也相应地增加了

Cardiac care in the 1970s was cheap.

20世纪70年代的心脏护理非常廉价

Because there was nothing we could do for you.

因为那时候人类对这种疾病束手无策

Today it's expensive, because we can do a lot.

现在的心脏护理极其昂贵 因为我们能做的太多了

And the new advances coming out every day will allow us to do more.

日益发展的新科技将会让我们能做的越来越多

If you had a bad hip in the 1970s, what was the answer?

如果你在20世纪70年代用坏了髋关节 那该怎么办呢？

Suck it up. You want to play golf? Eh, play a little less golf.

忍着吧 想打高尔夫球？嗯 少打点吧

Today, we can do a hip replacement in 38 minutes.

现在 我们可以在38分钟内置换髋关节

Because we're able to keep people alive longer, they live into their '80s and '90s.

人类寿命得到了延长 可以活到八九十岁

The bulk of health care expenditures are spent on older people at the end of life the last year to year and a half of life.

大部分的医疗开支都花在了老人的晚年治疗上

And also, because we can keep you alive longer,

而且 因为人均寿命延长了

we have now new diseases that are occurring that we didn't have before like Alzheimer's.

现在出现了一些以前从没见过的新疾病 比如老年痴呆症

You can't be talking about all of those great things and at the same time talk about,

你不能在享受成果和便利的同时还说

'Well, you know, we spent 6% of our GDP in the 1960s on health care.

“20世纪60年代的医疗开支只占GDP的6%

Why are we spending 17% today?'.

为什么现在它却占到了17%呢？”

Because we can do a heck of a lot more today.

因为今天我们能做的治疗多了很多

That does not mean that we don't have efficiencies that we can need to work on,

这并不代表我们做事效率低下

or that we are not inefficient in certain areas, or that we don't overspend in certain areas.

也不代表我们在某些领域效率不够 或者说我们没有在某些领域开支过度

But I'm a big believer that the overall cost of health care will never come down.

但我坚信整体的医疗开支水平永远都降不下来

The best you will be able to is slow the rate of growth.

你最多能做的就是减缓它的增长速度

That's different from what we should be doing to make sure that people's out-of-pocket expenses don't become a barrier to getting care.

这不同于我们为了确保不让人们荡尽家财成为他们获得治疗的障碍所做的努力

We've got two different issues.

这不是一码事儿

People confuse them all the time.

人们总会弄混

People say, I have to pay more out of my pocket, therefore, health care is costly.

人们会说 我必须得自付更多费用 所以医疗很昂贵

Yeah, but you're not going to fix the overall cost. You've got to fix this issue.

没错 但你解决不了整体开支 你得处理这个问题

The cost growth can be reduced.

开支增长速度可以放缓

But coming from 17% of GNP to 10% of GNP? That'll never happen.

但是从国民生产总值的17%降至10%？那是不可能的