Name: 為什麼生病會這麼貴？ | 追逐人生 (Why it costs so much to get sick | Chasing Life)
Uploaded: 2025-11-24T16:58:06.000Z
Duration: 39 min 35 s

Well, Dr. Rosenthal, thank you for joining us.

好的，Dr. Rosenthal，謝謝您來參加我們的節目。

這個 podcast 的名字是 Chasing Life。

Yes, every day I feel like I'm chasing life, and particularly about this topic that I'm obsessed about.

是的，我每天都覺得自己在追逐人生，特別是關於我著迷的這個主題。

I'm just trying to figure out how to make it better for people, which has kind of been my journalistic mission for decades.

我只是想弄清楚如何讓大家的生活變得更好，這幾十年來一直是我記者的使命。

Yeah, well, I do want to get into that background because I find it fascinating, and I think you and I share a lot of connective tissue in this regard.

是啊，我確實想深入瞭解這個背景，因為我覺得它非常吸引人，而且我想我們在這方面有很多連結點。

But what is the specific topic that you find fascinating?

但你覺得引人入勝的具體主題是什麼呢？

Well, you know, generally our health care system doesn't deliver to patients in terms of quality of care and in terms of the prices we get charged.

嗯，你知道，總體來說，我們的醫療保健系統在照護品質和我們被收取的價格方面，都無法讓病患滿意。

So what I worry about right now, and particularly in this season of renewing insurance, is, is that people avoid going to see doctors and avoid going to the hospital because they're just afraid of the bad experiences they've had.

所以，我現在擔心的是，尤其是在保險續約的這個時期，大家是不是因為害怕過去不好的經驗，而不敢去看醫生、不敢去醫院。

And they don't trust doctors or hospitals because they've had bad and very expensive experiences.

而且他們不信任醫生或醫院，因為他們有過糟糕又非常昂貴的經驗。

We did a podcast and a series of articles called Diagnosis Debt, and it's about 100 million Americans have medical debt now, and that's just going to go up if people don't have insurance.

我們做了一個podcast和一系列文章，叫做「診斷債務」，大約有一億美國人現在有醫療債務，如果大家沒有保險，這個數字只會繼續上升。

And what we're seeing now threatens to leave millions of more people uninsured.

而我們現在看到的，可能會讓數百萬人失去保險。

So when you talk about the bad experience, you're primarily talking about it from a financial standpoint.

所以，當你說到糟糕的經驗時，你主要是從財務角度來說的。

There's other things, obviously, but the sort of diagnosis debt, as you call it, no, I think it's multifaceted, because I think most hospitals run as businesses now.

當然還有其他方面，但你說的「診斷債務」，我覺得它是多方面的，因為我認為現在大多數醫院都是以企業模式營運。

I mean, I think you and I both know that.

我的意思是，我想你我都知道這件事。

And so, you know, there's one thing I'm obsessed with is ER boarding, how much time people spend in emergency rooms.

所以，你知道，有一件事我非常關注，就是急診室滯留，人們在急診室裡待了多久。

And, you know, that's largely a financial decision.

而且，你知道，這很大程度上是一個財務決策。

It's probably tmi, but my husband who died earlier this year.

這可能有點太多了，但我先生今年稍早過世了。

Well, he, in his final admission, spent three days in the er, and I knew there were elective admissions coming into the hospital.

嗯，他最後一次住院時，在急診室待了三天，我知道還有其他預定的入院病患。

But I think, you know, this is an older guy with stage 4 cancer who's just going to take up a bed and won't generate any revenue and will be a placement problem, you know, if he doesn't happen to die on this admission, which he, in fact, did.

不過我認為，你知道，這是一位罹患第四期癌症的年長病患，他會佔用病床，卻無法產生任何營收，而且如果他這次住院沒有過世的話，他就會成為安置上的問題，你知道的，而事實上，他確實過世了。

I mean, you try and make an appointment for physical therapy or a neurologist or an endocrinologist, and it's, you know, two, three months out because, you know, hospitals want to run as full ships all the time and the weights are terrible, the phone trees.

我的意思是，你試著預約物理治療、神經內科或內分泌科醫生，結果要等兩、三個月，因為你知道，醫院總是希望滿載運營，而且等待時間很長，電話系統也很糟糕。

You know, talk about a bad use of AI assistance.

你知道，談論到AI輔助的糟糕應用。

You know, there are multiple bad experiences that go well beyond the cost, but I think they're all related to, you know, what?

你知道，有很多糟糕的經驗遠不止於費用，但我覺得這些都跟，你知道，什麼有關？

I wrote my book about how healthcare became big business.

我寫了我的書，關於醫療保健如何變成大企業。

And I'm not sure there are good ways to take it back individually, frankly.

而且說實話，我不確定是否有好的方法可以個別地將它奪回來。

Okay, well, that's sort of a little bit of what I wanted to pivot some of this conversation around, which is how did we get here and how do we get out?

好的，這大概是我想要將部分對話轉向的內容，也就是我們是怎麼走到這一步的，以及我們該如何走出去？

那麼，我們就從「我們是怎麼走到這一步的？」開始吧。

Because, you know, you and I have both evaluated healthcare systems around the world, and I think when you do that, the consensus always is, look, there are things that work well with our healthcare systems, but many, many things that don't.

因為你知道，你和我都在世界各地評估過醫療保健系統，而且我認為當你這麼做時，大家的共識總是，看，我們的醫療保健系統有些地方做得很好，但也有很多很多地方做得不好。

Some of which of you have alluded to, did we get here through a process of natural evolution or what were the weird sort of forces that got us to this place?

就像你們有些人提到的，我們是自然演進到這一步的，還是有什麼奇怪的力量把我們帶到這裡來的？

Well, I would call it more unnatural evolution.

嗯，我會說這更像是非自然的演進。

You know, basically the idea of insurance goes way back to the turn of the last century where it was really more like, you know, you know, disability insurance.

你知道，基本上保險的概念可以追溯到上個世紀初，那時候比較像是，你知道，你知道，殘疾保險。

It was pay, which you got because you couldn't go to work.

也就是因為你無法工作而需要支付的費用。

And, you know, hospital stays were inexpensive.

而且，你知道，住院的費用也很便宜。

So it didn't, it really wasn't about that.

Then around that time, a teacher's union in Texas decided to have insurance for their employees.

然後差不多在那時候，德州的教師工會決定為他們的員工提供保險。

And some employers developed, you know, on site clinics to help their employees.

有些僱主也開發了，你知道，現場診所來幫助他們的員工。

But the big change was really post World War II when there was a labor shortage and companies started offering health insurance as a perk, you know, and that was a big thing.

但真正的重大轉變是在二次世界大戰後，當時出現了勞動力短缺，公司開始提供健康保險作為福利，你知道，這是一件大事。

So then there were all these people who had insurance which was tied to their jobs, and more people got insurance that was tied to their jobs.

所以那時候有很多人擁有與工作掛鉤的保險，越來越多人擁有與工作掛鉤的保險。

And then in 1963, you, you know, people over 65 didn't have jobs, so they were just like flailing in the wind, unable to bear the cost.

然後在1963年，你知道，65歲以上的人沒有工作，所以他們就像在風中飄盪，無法負擔費用。

所以Medicare就這樣開始了，來幫助他們。

And the problem is, and I call insurance the original sin.

Not because it's bad to have insurance, it's kind of a must have, but because it for many years separated the patients from the cost.

不是說有保險不好，這其實是必需品，而是因為很多年來，它讓病患與費用脫鉤了。

So, you know, when I had my children in the 90s, I paid nothing.

所以，你知道，我在90年代生小孩的時候，我什麼都沒付。

我付的錢大概是為了在房間裡看第四臺。

So I didn't really care how much was being charged.

所以我真的不太在意被收了多少錢。

And of course, what happens kind of organically or evolutionarily is some doctors realize, hey, you know, entrepreneurial doctors, it doesn't matter how much I charge because the patients aren't going to feel it right then what the.

當然，有機或演化上發生的事是，有些醫生意識到，嘿，你知道，有創業精神的醫生，我收多少錢都沒關係，因為病患當下不會感覺到，然後。

Another big step which I learned when I was writing my book was, you know, in the 1990s, there was this era of HMOs and they were really putting the squeeze on hospitals.

另一件我寫書時學到的大事是，你知道，在1990年代，那是一個HMO的時代，他們真的在壓榨醫院。

And so hospitals called in business consultants like McKinsey & Bain, Boston Consulting Group, and they said they looked at hospitals procedures and how they operated.

所以醫院就找了像 McKinsey & Bain、Boston Consulting Group 這樣的企業顧問來，他們檢視了醫院的流程和營運方式。

And they said, guys, you're leaving all this money on the table.

他們說，各位，你們錯失了好多賺錢的機會。

Like, you know, when I was an ER doctor, I came with the er, but the inside of business was like, wow, you can charge separately for that doctor and for that IV bag and for the nurse who's inserting the needle.

像是，你知道，我以前是急診室醫生，我負責急診室，但裡面的商業運作是，哇，你可以分開收取醫生的費用、點滴的費用，還有幫你打針的護士的費用。

like, when patients are in the recovery room, why are you giving that away for free?

像是，病患在恢復室的時候，為什麼你們要免費提供？

And not only that, you can charge in 15 minute intervals.

而且不只這樣，你們可以以 15 分鐘為單位收費。

而且我知道你是一位外科醫生。

Like, why are people in the recovery room?

像是，為什麼病患會在恢復室裡？

Sometimes it's because they need to like, come out of anesthesia.

有時候是因為他們需要，像是，從麻醉中醒來。

And sometimes the extra half hour is because their team is having dinner.

有時候多出來的半小時是因為他們的團隊正在吃晚餐。

And so, you know, we've gotten to this place where everything is billed, each little, every pill, every interaction.

然後，你知道，我們就來到了這個階段，所有東西都要計費，每一顆藥、每一次互動。

And then what happened is as a reaction to that, the insurers said, oh, we've got to, you know, let patients have some skin in the game.

然後接下來發生的是，作為對此的回應，保險公司說，喔，我們必須，你知道，讓病患也出一點力。

You know, there was, there were CO pays which were kind of minimal, and there was a deductible which wasn't very much.

你知道，當時有共付額，那時候還很少，還有自負額，金額也不高。

But those little bits of change didn't really.

So over time, the deductibles have gone up.

所以隨著時間過去，自負額就越來越高了。

So I think some people have $9,000 deductible plans.

所以我覺得有些人有九千美元的自負額計畫。

In addition to CO pays, there's coinsurance, which is 20% often for hospital stays.

除了共付額之外，還有保險分攤，住院時常是百分之二十。

And you know, man, if you're in the ER for, you know, four hours, that's 10,000 bucks probably, and your portion is 2,000.

而且你知道，天啊，如果你在急診室待了，你知道，四小時，可能就要一萬塊，而你的部分是兩千塊。

We're at this kind of critical juncture where we put efficiency ahead of patient care.

我們正處於一個關鍵的轉折點，我們把效率置於病患照護之上。

And we've sacrificed a lot of patient care in the name of efficiency.

我們犧牲了很多病患照護來追求效率。

And you know, I say we as a kind of lapsed physician, but we've lost the population in that process.

而且你知道，我以一個曾經的醫生來說，我們在這個過程中失去了大眾。

You know, I think this was something of a big deal during the pandemic when, you know, physicians were saying you need to get vaccinated.

我覺得這在疫情期間是件大事，當時，你知道，醫生們說你需要接種疫苗。

But a lot of people didn't have a doctor they trusted.

I do want to get at this idea of where we should go, but let me focus in on something that you brought up a couple times.

我想探討我們應該走向何方，但讓我們先聚焦在你提過幾次的點上。

This idea of cost sharing, of having skin in the game.

這個「費用分攤」的概念，也就是「自己也要有所投入」。

When you had your kids back in the 90s, it was free.

你在 90 年代生小孩的時候，是免費的。

Patients were largely insulated from cost.

病患在很大程度上不受費用的影響。

So they weren't effective negotiators in terms of trying to bring those costs down because they didn't really care.

所以他們在降低成本方面不是有效的談判者，因為他們其實不太在意。

他們甚至常常看不到實際的數字。

Then you started having more cost sharing, sort of incremental at first in terms of co pays, but higher, higher sort cost sharing with high cost deductible plans, things like that.

然後你開始看到更多的費用分攤，起初是漸進式的，像是較高的掛號費，但後來是更高、更高的費用分攤，像是高自付額的保險計畫等等。

字幕列表影片播放

為什麼生病會這麼貴？ | 追逐人生 (Why it costs so much to get sick | Chasing Life)

sort

period

experience

chaos