是什麼讓美國的醫療體系如此昂貴?_風聞

【來源龍騰網】

評論原創翻譯：

Jacob VanWagoner

Why are healthcare costs in the United States so incredibly expensive?

There are a number of identifiable causes, and I will cite examples where possible.

1) Constriction of supply.

Health care is one of those interesting problems in economics where it’s essential enough that a significant number of people will go for anything that might help at any cost. While in a normal market, “anything that might help at any cost” doesn’t lead to massive price ramps because high margins with high volumes draw in competitors who undercut each other, in health care it doesn’t because supply is constricted in various ways. (Thanks Jim Kenyon for mentioning the oddities of the health care market).

為什麼美國的醫療費用如此昂貴？

有許多可識別的原因，我儘可能列舉一些例子。

1、供給緊縮

醫療保健是經濟學中有趣的問題之一，它是足夠重要的，以至於很多人會不惜任何代價去做對其可能有所幫助的事情。而在一個正常的市場中，“不惜任何代價去做對其可能有所幫助的事情”都不會導致價格大幅上漲，因為高利潤和高銷量吸引了競爭對手相互削價，但在醫療保健領域，情況並非如此，因為供方受到了各種方式的限制。(感謝吉姆·凱尼恩提到醫療保健市場的古怪之處)。

a) Regional monopolies (mentioned by Shane Bogusz)

Regional monopolies are, for the most part, dictated by law. Certificate of need laws are explicit in 35 states, and the remaining 15 states are required to meet a national certificate of need-like requirement.

Certificate of Need laws are a requirement that any new medical facility must first obtain a certificate from the state health agency (pretty much staffed by the hospital administrators) before the facility can be constructed.

An equivalent in other markets might be this:

You have a new microprocessor design that, according to simulations, give much better power efficiency with very good performance per clock cycle, and you have the design and everything ready to go. But before you are allowed to sell this microprocessor, you must first get permission from Intel, and they must verify that they are unable to reach the entire desired market with their products before they will allow you to sell it.

In other words, keep competitors out so you can keep prices high.

In Utah, the Certificate of Need requirement is not in effect, and its costs per person are among the lowest and its outcomes are among the best. In most states or regions, there is a single hospital network -- many facilities, but all owned by the same group, but in Utah there are many. The University of Utah health network operates entirely independently from the Intermountain Health Care network, which operates independently from the Mountain Star Network -- and that’s just in the Salt Lake City metro area.

a） 區域壟斷（Shane Bogusz提到）

區域壟斷在很大程度上是由法律決定的。35個州制定了明確了法律規定所需證件，其餘15個州必須提供類似的所需證件。

法律規定所需證件，任何新的醫療設施在建設之前都必須首先從國家衞生機構（幾乎由醫院管理人員組成）獲得證件。

其他市場的類似情況可能是：

你有了一個新的微處理器設計，根據模擬，每個時鐘週期的性能都很好，功率效率更高，你的設計和一切都準備好了。但在你被允許銷售這款微處理器之前，你必須首先獲得英特爾的許可，他們也必須在允許你銷售產品之前，核實他們的產品無法觸達整個市場。

換句話説，把競爭對手擋在門外，這樣你就可以讓你的產品保持高價格。

在猶他州，所需證件方面的法律沒有生效，人均成本最低，結果最好。在大多數州或地區，都有一個單一的醫院網絡——眾多設施都歸同一集團所有，但在猶他州，眾多設施歸眾多集團所有。猶他大學的醫療網絡完全獨立於山間醫療網絡運營，山間醫療網絡獨立於山星網絡運營，而該網絡就在鹽湖城都會區。

原創翻譯：龍騰網 https://www.ltaaa.cn 轉載請註明出處

b) Educational supply restriction and barrier to entry.

Now why did this happen?

It’s doctors who control the number of doctors in America, not the government.

Yes, the article is from a left wing rag, and the article is clearly slanted to portray anything resembling a free market as the worst possible thing, but the information is accurate -- the system is designed so doctors don’t undercut themselves with hordes of new doctors.

There are many possible education/occupational models that can grant certification and ensure new entrants have sufficient experience, but the one we’re stuck with right now is the one where doctors get to control how many new guys enter their field.

Furthermore, the cost of education is ridiculous, putting up a huge barrier to entry, essentially making it required that doctors are paid extremely well in order to justify the high price of the education.

Credit: KevinMD - Medical education cost is a health policy imperative

I would almost call that enslavement. At that cost, there’s no way you could afford to be doling out low-price care to those who need it without having another way to make money. There’s no way you could choose any other profession except perhaps high-paid salesman/consultant. On a 30 year term with a 4% interest rate, that’s somewhere around $800/mo (didn’t do actual calculation, just estimates). It’s comparable to owning a second house, but without the benefit of being able to sell it or live in it.

In any case, the high cost of education is yet another way the medical industry constricts supply.

And it really shows. Just Google “doctor shortage” and you’ll get a ton of hits lixing to studies, etc.

b） 教育供給限制和入學障礙。

為什麼會發生這種情況？

控制美國醫生數量的是醫生，而不是政府。

是的，這篇文章來自左翼，而且這篇文章顯然傾向於將任何類似自由市場的事情描繪成最糟糕的事情，但信息是準確的——這個系統的設計是為了不會出現大批新醫生，從而讓醫生自己變得廉價。

有很多可能的教育/職業模式可以授予認證，並確保新進入者有足夠的經驗，但我們現在遇到的問題是，醫生可以控制進入醫生領域的新人數量。

此外，教育成本高得離譜，這為醫生的進入設置了巨大的障礙，基本上要求醫生獲得極高的報酬，以證明高昂的教育成本是合理的。

來源：KevinMD-醫學方面的教育成本是醫療政策的當務之急

我幾乎會稱之為奴役。在這樣的成本下，你不可能在沒有其他賺錢途徑的情況下，向那些有需要的人提供低價醫療服務。除了高薪的推銷員/顧問，你不可能選擇任何其他職業。在利率為4%的30年期貸款中，大約是每月800美元(沒有實際計算，只是估計)。這相當於擁有第二套房子——但不能出售它、不能居住。

總之，高昂的教育成本是醫療行業限制供應的另一種方式。

這真的很明顯。只要在谷歌上搜索“醫生短缺”，你就會獲得研究這方面的大量鏈接。

2) Price opacity.

a) hiding the price.

Good luck finding the price of a procedure, no matter how routine or obscure, voluntary or involuntary it is.

Peeling Away Health Care’s Sticker Shock

The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy

2、價格不透明。

a） 隱藏價格。

祝你好運，找到一個程序的價格，無論多麼常規或模糊的，自願或非自願的。

剝去醫療服務的價格衝擊

美國醫院服務定價:秘密面紗背後的混亂

b) Insurance games.

Classically, insurance is supposed to be about protecting your assets -- that is, paying for replacement in the case of something lost, stolen or broken, paying for property damage that you caused by your accident in a car, or other such things. In no other industry is it “pay for everything,” but rather a “pay for everything that you can’t afford” system.

In other industries, insurance pays the total value of damages. In cases where there is a lawsuit, insurance will settle out of court for less than the amount of the lawsuit to avoid the risk of losing money.

In health care, it is not so. For many people, insurance pays for everything, minus copays. The person receiving the service is disconnected from payment and therefore has little to no power to negotiate. Combined with the restriction of supply, the consumer really doesn’t have much power at all. Furthermore, the explanation of benefits and/or bills for service are almost completely BS.

b） 保險遊戲。

傳統上，保險應該是為了保護你的資產——也就是説，在東西丟失、被盜或損壞的情況下支付補償費，支付因車禍或其他類似事件造成的財產損失。在其他行業中，沒有一個是“為一切買單”，而是“為你負擔不起的一切買單”。

在其他行業，保險支付損失的全部價值。在發生訴訟的情況下，保險公司將以低於訴訟金額的金額庭外和解，以避免損失金錢的風險。

在醫療保險領域，情況並非如此。對許多人來説，保險支付自付額之外的一切費用。接受醫療服務的人不參與付款，因此幾乎沒有談判的權力。再加上供應的限制，消費者真的沒有太多的權利。此外，對福利和/或服務賬單的解釋幾乎完全是胡扯。