是什么让美国的医疗体系如此昂贵?_风闻

【来源龙腾网】

评论原创翻译：

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).

为什么美国的医疗费用如此昂贵？

有许多可识别的原因，我尽可能列举一些例子。

1、供给紧缩

医疗保健是经济学中有趣的问题之一，它是足够重要的，以至于很多人会不惜任何代价去做对其可能有所帮助的事情。而在一个正常的市场中，“不惜任何代价去做对其可能有所帮助的事情”都不会导致价格大幅上涨，因为高利润和高销量吸引了竞争对手相互削价，但在医疗保健领域，情况并非如此，因为供方受到了各种方式的限制。(感谢吉姆·凯尼恩提到医疗保健市场的古怪之处)。

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） 区域垄断（Shane Bogusz提到）

区域垄断在很大程度上是由法律决定的。35个州制定了明确了法律规定所需证件，其余15个州必须提供类似的所需证件。

法律规定所需证件，任何新的医疗设施在建设之前都必须首先从国家卫生机构（几乎由医院管理人员组成）获得证件。

其他市场的类似情况可能是：

你有了一个新的微处理器设计，根据模拟，每个时钟周期的性能都很好，功率效率更高，你的设计和一切都准备好了。但在你被允许销售这款微处理器之前，你必须首先获得英特尔的许可，他们也必须在允许你销售产品之前，核实他们的产品无法触达整个市场。

换句话说，把竞争对手挡在门外，这样你就可以让你的产品保持高价格。

在犹他州，所需证件方面的法律没有生效，人均成本最低，结果最好。在大多数州或地区，都有一个单一的医院网络——众多设施都归同一集团所有，但在犹他州，众多设施归众多集团所有。犹他大学的医疗网络完全独立于山间医疗网络运营，山间医疗网络独立于山星网络运营，而该网络就在盐湖城都会区。

原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处

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） 教育供给限制和入学障碍。

为什么会发生这种情况？

控制美国医生数量的是医生，而不是政府。

是的，这篇文章来自左翼，而且这篇文章显然倾向于将任何类似自由市场的事情描绘成最糟糕的事情，但信息是准确的——这个系统的设计是为了不会出现大批新医生，从而让医生自己变得廉价。

有很多可能的教育/职业模式可以授予认证，并确保新进入者有足够的经验，但我们现在遇到的问题是，医生可以控制进入医生领域的新人数量。

此外，教育成本高得离谱，这为医生的进入设置了巨大的障碍，基本上要求医生获得极高的报酬，以证明高昂的教育成本是合理的。

来源：KevinMD-医学方面的教育成本是医疗政策的当务之急

我几乎会称之为奴役。在这样的成本下，你不可能在没有其他赚钱途径的情况下，向那些有需要的人提供低价医疗服务。除了高薪的推销员/顾问，你不可能选择任何其他职业。在利率为4%的30年期贷款中，大约是每月800美元(没有实际计算，只是估计)。这相当于拥有第二套房子——但不能出售它、不能居住。

总之，高昂的教育成本是医疗行业限制供应的另一种方式。

这真的很明显。只要在谷歌上搜索“医生短缺”，你就会获得研究这方面的大量链接。

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、价格不透明。

a） 隐藏价格。

祝你好运，找到一个程序的价格，无论多么常规或模糊的，自愿或非自愿的。

剥去医疗服务的价格冲击

美国医院服务定价:秘密面纱背后的混乱

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） 保险游戏。

传统上，保险应该是为了保护你的资产——也就是说，在东西丢失、被盗或损坏的情况下支付补偿费，支付因车祸或其他类似事件造成的财产损失。在其他行业中，没有一个是“为一切买单”，而是“为你负担不起的一切买单”。

在其他行业，保险支付损失的全部价值。在发生诉讼的情况下，保险公司将以低于诉讼金额的金额庭外和解，以避免损失金钱的风险。

在医疗保险领域，情况并非如此。对许多人来说，保险支付自付额之外的一切费用。接受医疗服务的人不参与付款，因此几乎没有谈判的权力。再加上供应的限制，消费者真的没有太多的权利。此外，对福利和/或服务账单的解释几乎完全是胡扯。