Can Healthcare Get Better? Some Foreign Stories

國(guó)外民眾眼中的醫(yī)保體制

A few months ago, Bilingual Time covered the different healthcare systems available worldwide, comparing the US' free market model with the single-payer insurance or national health systems of other developed countries. This month, we talked to or gathered testimonies from people all around the world, providing a more intimate account of different options in healthcare.

幾個(gè)月前,《雙語(yǔ)時(shí)代》介紹了全世界不同的醫(yī)療保健體制,比較了美國(guó)的自由市場(chǎng)模式下的單一付款人保險(xiǎn)同其他發(fā)達(dá)國(guó)家的國(guó)民健康保健體制。本月,我們同來自世界各地的人們進(jìn)行了交談,搜集了一些證言,更為詳盡地介紹不同的醫(yī)療保障體制。

USA 美國(guó)

A little over five years ago, I was diagnosed with testicular cancer. Even with my insurance, it still took me years to pay off the thousands of dollars of out-of-pocket costs.

五年多以前,我被診斷患有睪丸癌。雖然我有保險(xiǎn),但還是花了幾年才還清了數(shù)千美元的自付金額。

After three years of follow-up visits, my insurance company told me that they no longer considered my hospital a provider for their plans. I had developed a relationship with the doctors, nurses, and staff at the hospital. They had been there during some of the toughest times of my life.

經(jīng)過三年的后續(xù)治療,我的保險(xiǎn)公司告訴我,他們不再指定我的醫(yī)院為他們保險(xiǎn)計(jì)劃的定點(diǎn)醫(yī)院。但我同這家醫(yī)院的醫(yī)生、護(hù)士和員工建立了不錯(cuò)的關(guān)系。他們伴我度過了生命中一些最艱難的時(shí)刻。

When it comes to a person's well-being there isn't much of a choice. Who chooses not to seek treatment for cancer? When the doctor tells you to do something or you will die, who says, 'Gee, that's a little more than I was hoping to spend today'? It isn't like choosing between Coke or Pepsi.

說起個(gè)人健康,我們可選的余地不多。誰得了癌癥不治療呢?當(dāng)醫(yī)生告訴你,如果不做些什么就會(huì)死時(shí),誰會(huì)說:“哎呀,這比我今天預(yù)計(jì)花費(fèi)的要多”呢?這可不像在可口可樂或百事可樂之間做選擇。

In certain ways the American health care system is absolutely amazing. We know how to remove a person's diseased heart, replace it with the heart of a cadaver, and have the person live out the rest of their life. Realistically, next to no one in America will ever have to worry about diseases like tuberculosis or malaria.

從某些方面來說,美國(guó)的醫(yī)療保健體制絕對(duì)值得稱贊。我們知道如何切除患者病變的心臟,然后換上死人的心臟,以延長(zhǎng)患者壽命。實(shí)際上,美國(guó)人完全不用擔(dān)心結(jié)核病或瘧疾等疾病。

On the other hand, the American healthcare system is by no means fair or egalitarian. It, like everything else in our capitalist society, favors the wealthy. There are people who will only go to the Mayo Clinic (an expensive and private clinic) to see a doctor, even if that means travelling across the country, while there are people who decide not to have that chronic cough checked out because it would mean less food on the table for the kids. In that way the American healthcare system is really screwed up, and it is a really complicated problem. For starters, it isn't just the doctors, hospitals, and insurance companies, it is every social aspect of a person's health. The rich can afford to eat better. They can afford the time it takes to get regular exercise. Most important, they can afford health care to be proactive and not just reactive. Does anyone really think that a single mother of four that has to work a couple of part time jobs to pay the bills can get to the gym three times a week?

-Brian Salmon, Chicago.

另一方面,美國(guó)的醫(yī)療保障體制一點(diǎn)也不公平,不是人人平等。它跟資本主義社會(huì)的其他一切事物一樣,更偏向富人。有人只到梅約醫(yī)療中心(一個(gè)昂貴的私人診所)看醫(yī)生,即使這意味著長(zhǎng)途跋涉。同時(shí)也有人不會(huì)因久咳不停去看病,因?yàn)檫@意味著餐桌上孩子的食物就少了。這樣看來,美國(guó)醫(yī)療保障體制非常糟糕,問題相當(dāng)復(fù)雜。首先,這不單是醫(yī)生、醫(yī)院和保險(xiǎn)公司的問題,而是個(gè)人健康所涉及到的各個(gè)社會(huì)層面的問題。富人吃得更好。他們有時(shí)間經(jīng)常鍛煉。最重要的是,他們能負(fù)擔(dān)得起預(yù)防性的醫(yī)療保健,而不僅是被動(dòng)就醫(yī)。有誰真的認(rèn)為一個(gè)有四個(gè)孩子、必須得做幾份兼職才能負(fù)擔(dān)生活費(fèi)的單身母親能一星期去三次健身房呢?

——布萊恩?薩爾蒙,芝加哥

I practice in a rural clinic in Vermont where I see the problems in health care up close. One in ten Vermonters are uninsured and another one in seven are underinsured, which means they have to scrape around to pay the first $5,000 to $10,000 in medical bills. They often avoid coming to the doctor and I have seen even young people die of preventable diseases. As a physician, I find it impossible to witness such atrocities and not get involved in reforming health care. It is clear to me that the only answer is to tackle rising health care costs and the financing of health care services in a systematic way that answers to everyone, not just to some. Let's face it, at some point, like every other nation in the world, we are going to have to view health care as a public good and publicly finance it, for everyone. To have a kind of Medicare for all.

-Dr Deborah Richler, Vermont

我在佛蒙特州的一家鄉(xiāng)村診所行醫(yī),可以真切地看到醫(yī)療保障的問題。十分之一的佛蒙特人都沒有保險(xiǎn),七分之一人的保險(xiǎn)值不足,這意味著他們得東拼西湊,才能支付醫(yī)療單上的頭5000到10000美元的費(fèi)用。他們經(jīng)常有病不看,我就見過年輕人死于本可以預(yù)防的疾病。作為一名醫(yī)生,我覺得不可能眼見著這種殘忍的事而不參與醫(yī)療保障改革。我很清楚,唯一的答案是系統(tǒng)地解決醫(yī)療費(fèi)上漲和醫(yī)保服務(wù)資金問題——滿足所有人的需要,而非只針對(duì)部分人。說實(shí)話,在某個(gè)時(shí)候,跟世界上其他國(guó)家一樣,我們得把醫(yī)療保健當(dāng)做公共福利,保證每個(gè)人的利益,并為其公開募集資金,實(shí)現(xiàn)全民醫(yī)療保障。

——德波拉?瑞奇醫(yī)生,佛蒙特州

I have a hole at the base of my spine and I have no health insurance. The condition is not life threatening, but it can be extremely painful. There is a surgery that would take care of this condition, but the procedure would cost thousands of dollars. The antibiotics alone are astronomically priced. So, I am not dying, but I can't do things I'd like to do like running or horseback riding. And now that it is a pre-existing condition, I doubt it will ever be covered. America lags behind in education, environmental issues and our own healthcare. Sometimes I wonder how much business we have 'helping' other countries when we can't even help our own.

-Erin Walker, Chicago

我的脊骨根部有一個(gè)洞,但我沒有醫(yī)療保險(xiǎn)。病情并不會(huì)威脅生命,但卻讓人非常痛苦。動(dòng)手術(shù)可以消除病癥,但得花數(shù)千美元。光抗生素就貴的驚人。所以,我并非命懸一線,可是一些我喜歡做的事就做不了了,如跑步和騎馬。這是老毛病了,我懷疑它好不了。美國(guó)在教育、環(huán)境問題和我們自身的醫(yī)療保健上比較落后。有時(shí)我很疑惑,我們連自己都幫助不了,還能“幫助”別的國(guó)家什么事情。

——伊琳?沃克,芝加哥

On February 7, 2008 our family was shattered when we lost our one and only son Clinton Ron Walker at the age of 17. For over a year, Clinton had suffered strange seizures that would rack his body and cause him to run, jump and moan for over 2 or 3 minutes. He went to the paediatrician who wanted to send him to a special clinic but my insurance denied our request. After months of visiting several doctors, our paediatrician found a new neurologist who was set to take on Clinton's case using my husband's insurance plan. The week that he was scheduled to see the new doctor Clinton died. We later learned he had a heart defect that caused his seizures. Had our insurance allowed us to take him to the special clinic where there was a cardiologist on staff we believe he could have been saved and alive today.

-Candace Walker, Stockbridge, Georgia

2008年2月7日,我們失去了我們唯一的兒子克林頓?榮?沃克,他年僅17歲,我們?nèi)叶急从^。在一年多的時(shí)間內(nèi),克林頓深受一種奇怪癲癇病的折磨。這種病發(fā)作時(shí)他會(huì)發(fā)抖,然后又跑又跳又呻吟達(dá)兩三分鐘。他去看了兒科醫(yī)生,醫(yī)生想把他送到一家特殊診所,但我的保險(xiǎn)公司拒絕了我們的要求。和多名醫(yī)生會(huì)診后,我們的兒科醫(yī)生找到了一個(gè)新的精神病醫(yī)生,這名醫(yī)生打算用我丈夫的保險(xiǎn)方案給克林頓看病。他卻在要去看這名新醫(yī)生的那個(gè)星期去世了。后來我們得知,他患有一種心臟病,這種病導(dǎo)致他的癲癇發(fā)作。如果我們的保險(xiǎn)允許我們帶他去特殊門診看病,我們相信那里的心臟病醫(yī)生可以救活他,他現(xiàn)在可能還活著。

——坎迪斯?沃克,喬治亞州斯達(dá)克橋鎮(zhèn)

UK 英國(guó)

Last Friday I learned what it was like to be part of a civilized, first world health system.

上周五,我見識(shí)到身處在一個(gè)文明的第一世界國(guó)家的醫(yī)療體制之下,是什么樣子。

I was in England, staying at my godmother's house, when I got slammed by one of my chronic migraines. When I get migraines I usually resign myself to a dark room, take my medication and wait for the nauseating pain and blurry vision in my left eye to dissipate.

當(dāng)時(shí)我在英格蘭,住在我的教母家,正被慢性偏頭痛所折磨。病情發(fā)作時(shí),我就呆在一個(gè)昏暗的房間,吃了藥,等這鉆心的疼痛和我左眼的模糊癥狀消失。

As I rummaged around my suitcase to find my salvation, high doses of Trexamet and Naprosyn, I discovered that I had forgot to pack them in my rush to the airport. Not having my medication doesn't mean enduring one bad headache. It means enduring about three days of completely crippling head pain. Instead of panicking over my fate, I picked up the phone and called my doctor in NY. I thought she'd be able to call in a prescription. No dice. She actually didn't even call me back. Plus, as my godmother reminded me, she wouldn't be able to call in a prescription because she's not part of the British health system.

我搜遍行李箱,想找到我的救星——大劑量的偏頭痛藥和消炎藥,突然發(fā)現(xiàn)由于我急著往機(jī)場(chǎng)趕,忘記帶了。沒有藥并不意味著就要忍受一次劇烈的頭疼,而是意味著頭疼欲裂達(dá)三天之久。但我并不慌張,而是拿起電話,給我在紐約的醫(yī)生打了個(gè)電話。我原以為她會(huì)打電話給藥店開處方,結(jié)果根本沒用,她甚至連電話都沒有給我回。而且,我的教母提醒我,她不能通過電話開處方,因?yàn)樗⒉粚儆谟?guó)醫(yī)保體制。

So I resigned myself back to my dark room, put a cloth over my head and tried to do what my mother always tells me: 'go to another place'. Well, my godmother came upstairs shortly afterward and suggested that she could take me to that other place... a National Health office.

所以我又回到小黑屋,頭上裹一塊布,試著做我媽經(jīng)常給我說的:“去另外一個(gè)地方?！边^了一會(huì)兒,我的教母上樓來,提出她可以帶我去另外一個(gè)地方……一間國(guó)民醫(yī)療保健辦事處。

Since I thought getting an appointment there would require a referral, at least a day's wait and an exorbitant amount of money, I told her not to bother. She called anyways, got me an appointment for the next hour and we were off to the neighborhood clinic.

由于我認(rèn)為預(yù)約需要有人介紹,至少等上一天,還要花一大筆錢,我跟她說不要費(fèi)心了。但她還是打了電話,給我預(yù)約了下個(gè)小時(shí),然后我們就去了附近的那家診所。

It was amazing. I filled out paperwork with my New York address, waited five minutes, met with the doctor, got a prescription, walked downstairs to the pharmacy under the clinic and was back at my godmother's house an hour later. Believe it or not, I didn't have to pay a cent for the visit. I did, however, pay a 'private' prescription price for the medication that added up to about $30 dollars – normally a British citizen would pay around $10 or $15.

我在文件上填寫了我在紐約的住址,然后等了五分鐘,和醫(yī)生見了面,拿了處方,下樓去藥店拿藥,一個(gè)小時(shí)后我就回到了教母家。這真是不可思議。信不信由你,我沒有花一分錢的門診費(fèi)。不過,我的確“自己”掏錢付了藥費(fèi),總共大約30美元,英國(guó)公民則通常交10或15美元左右。

I'm not denying that there are problems with the British system. My problem wasn't life threatening, but it was temporarily crippling. For people with deadly diseases like cancer there are documented frustrations over access to certain treatment. My great-uncle actually got sent home from a British hospital because there weren't enough beds that day. He was scheduled for open heart surgery... an operation he endured the following week.

我并不否認(rèn)英國(guó)體制存在問題。我的病并不會(huì)威脅生命,但有時(shí)會(huì)讓人崩潰。對(duì)于罹患癌癥等致命疾病的人來說,的確有人無法接受某些治療,有例為證。我舅爺被一家英國(guó)醫(yī)院送回家,原因是當(dāng)天沒有足夠床位。他預(yù)約接受心臟手術(shù),在下個(gè)星期做了手術(shù)。

There will always be problems in a system that takes care of millions, but that shouldn't preclude us from not giving millions their rights to proper health care. What Obama said about energy applies to health care: 'Don't let the perfect be the enemy of the good.' From my experience the British system was good. It was also good to my great-uncle. Even though he was sent home, he was treated. His immediate family didn't have to haggle with insurers or cut costs. His country took care of him. America should be able to do the same.

-Katherine Zalewski

一個(gè)涉及成百上千萬人的制度,不可能不存在問題,但我們不應(yīng)該因此就不給廣大群眾享受醫(yī)療保障的權(quán)利。奧巴馬就能源問題所說的話也適用于醫(yī)療保障:“不要讓追求完美成為做好事的敵人?！币晕业慕?jīng)歷看來,英國(guó)體制挺好。對(duì)我舅爺也好。雖然他被送回家,但是仍然接受了治療。他的家人不必跟保險(xiǎn)公司糾纏,也不需要節(jié)衣縮食。他的國(guó)家會(huì)照顧他。美國(guó)應(yīng)該也這樣做。

——?jiǎng)P瑟琳?查勒維斯基

When I was a little girl - I was born in 1929 - going to see the doctor was a big affair. It was expensive, for a start, especially for the poor families. We were respectable middle-class, so we could afford to go if we were sick, but a lot of people couldn't, so they ended up going to quacks and charlatans or not going at all. There were always doctors who'd volunteer and free clinics, but they were a minority. By the time I was an adult we had the NHS, and you wouldn't believe some of the fuss the doctors were kicking up about it at first, claiming it was an infringement of their rights and all this. The BMA – the British Medical Association – was set against it from the start, although they came round. But it made an astonishing difference to health in this country. I was a nurse, and I can tell you, you could tell the difference between kids after the war and kids before – conditions that would have gone untreated for years beforehand, and got worse, were fixed, infant mortality dropped, all good things.

-Cecile Goddard

我還是個(gè)小女孩的時(shí)候——我出生于1929年——看病可是一件大事。首先,看病非常昂貴,尤其是對(duì)于窮人家庭。我們是體面的中產(chǎn)階級(jí),生了病還有錢看醫(yī)生,但許多人卻不能,所以他們就去找江湖醫(yī)生或騙子醫(yī)生,有時(shí)甚至連醫(yī)生都不找。總有一些志愿者和免費(fèi)診所,但很少。我長(zhǎng)大成人之后,有了國(guó)民醫(yī)保體制,醫(yī)生一開始對(duì)此很不滿意,說它侵犯了他們的權(quán)益,等等。英國(guó)醫(yī)師協(xié)會(huì)從一開始就反對(duì),不過后來改變了態(tài)度。但它給國(guó)家的醫(yī)療衛(wèi)生帶來了巨大變化。我曾經(jīng)是一名護(hù)士,我可以告訴你,你可以辨別出戰(zhàn)后的孩子與之前孩子的區(qū)別——以前多年得不到診治,進(jìn)而惡化的疾病,現(xiàn)在得到了治療,嬰兒的夭折率有所下降,好處多多。

——塞西爾?古達(dá)德

I was amazed when I got here, and was told I could just go and register with a local doctor for free. I wasn't even on a work visa yet when I did it, though I was going to switch soon; they just said 'Oh, no problem, we'll put you down anyway.' And it all being free was just amazing to me, even though everything was a little bit darker and dingier than it would have been in the States. Like, there the doctor's surgery is always sparkling clean – I mean, not that it wasn't clean here, but it wasn't polished to a shine like it would have been back home, where a lot of it is about appearance.

-Lizzie White

我來到這里之后感到很驚訝,人們告訴我說,我可以免費(fèi)在一名當(dāng)?shù)蒯t(yī)生那里注冊(cè)。雖然我正打算換為工作簽證,但我注冊(cè)時(shí)還沒有工作簽證;他們只是說 “噢,沒問題,我們這就給你辦理?！倍彝耆赓M(fèi),這也令我感到不可思議,盡管設(shè)施沒有美國(guó)那么干凈明亮。比如,在那里(美國(guó)),診所總是干凈整潔——我的意思是說,并不是這里不干凈,而是沒家鄉(xiāng)那里的光鮮明亮,但那里很大程度上只是外表功夫。

——莉茲?懷特

Germany 德國(guó)

All German workers pay the same amount of our income, about 8%, into a healthcare fund, and the government matches that. That way we provide universal coverage. Obviously children, the unemployed, the elderly, and those who can't work for health reasons don't have to pay. If I don't make a lot of money, I don't have to pay a lot of money for health insurance. But I have the same access to health care that someone who makes more money has. 8% is a sizable bite – but I read that in America, employee health insurance is about 18% of their gross income, so it doesn't feel so bad. And considering what you get for it, it's worth it.

-Sabina Essler

所有的德國(guó)工人都將約8%的收入交給醫(yī)?；?政府承擔(dān)同等金額。我們通過這種方式提供全民醫(yī)保。很顯然,兒童、無業(yè)人士、老人和因?yàn)榻】祮栴}無法工作的人不用交。如果我掙的錢不多,我就不用掏很多錢負(fù)擔(dān)醫(yī)療保險(xiǎn)。但我跟其他掙錢比較多的人一樣享受醫(yī)療保障。8%不是個(gè)小數(shù)目,但我聽說在美國(guó),職工保險(xiǎn)費(fèi)要占他們總收入的18%,所以我感覺還不算很糟。再想想你所得到的,還是挺值的。

——薩比娜?埃斯勒

Italy意大利

My 70-year-old father was knocked down by a horse-drawn carriage in Florence on a visit this May. Although he didn't lose consciousness, we were worried that he could have a head injury. We went to the closest hospital, which turned out to be the smallest, most crowded, and, according to our friends, the 'worst'. He was triaged as a 'green' patient (stable) upon arrival, received xrays and an MRI. Because he's on anticoagulants for a heart condition, they wanted him to remain overnight for observation, but they didn't have a room. He was given comprehensive discharge instructions so that he could follow up with his own physician. My mother and I followed the instructions with respect to observing him for the next 24 hours, with no complications. He was not charged for the treatment. The entire episode lasted four and one-half hours. Italy isn't an efficient country normally, and there are lots of stories of healthcare scandals, but I must say that when it comes to looking after people in an emergency, my country makes me proud.

-Umberto Zen

今年五月,我70歲的父親在佛羅倫薩旅游時(shí)被一輛馬車撞倒。雖然他沒有失去知覺,但我們擔(dān)心他頭部會(huì)受傷。我們?nèi)チ俗罱囊患裔t(yī)院,去了之后才發(fā)現(xiàn)這是最小、最擁擠的,據(jù)我們的朋友說,還是“最糟糕的“的醫(yī)院。他剛到就被定為病情穩(wěn)定,然后接受了X光和核磁共振檢查。由于他患有心臟病,注射了抗血凝劑后,他們要他晚上住院觀察,但醫(yī)院沒有病房。醫(yī)院給了他許多出院指導(dǎo),可以找他自己的醫(yī)生進(jìn)一步診治。我母親和我嚴(yán)格遵照醫(yī)院的指導(dǎo),觀察了24小時(shí),沒有發(fā)現(xiàn)新問題。他這次看病沒有花錢。整個(gè)過程總共耗時(shí)四個(gè)半小時(shí)。意大利通常不是一個(gè)高效率的國(guó)家,有許多醫(yī)療丑聞,但我必須說,在人民需要緊急照顧時(shí),我的祖國(guó)令我感到驕傲。

——昂貝爾托?森