事件记录
面试官: 目前美国医疗保健面临的主要问题是什么? It seems like there are so many of them and it could be confusing and hard to sort out what exactly is going on. 好吧，大发娱乐请到了一位专家，他将在接下来的《大发娱乐》节目中大发娱乐大发娱乐做到这一点.
播音员: 大发娱乐是你的每日科学，对话，医学. 大发娱乐是犹他大学健康科学电台的Scope.
面试官: Dr. 大卫Sundwall is a professor of public health at University of Utah School of Medicine. 他也是医疗保健政策和倡导的领导者. 因此，大发娱乐都希望人人都能负担得起并享有高质量的医疗保健. 你认为大发娱乐可以做些什么来实现这个目标?
Dr. Sundwall: 好吧, this is where I have to be careful because I start sounding like a socialist. 我是共和党人，支持单一付款人制度. 我认为 if we have something more like what they have 然后 other enlightened countries, 不管是加拿大、德国还是瑞士, where they spend a lot less than we do for health care but somehow manage to cover all of their citizens, 这就是大发娱乐最终想要达到的.
That's a long time coming because there's such a reluctance in our country to have this uniformity. 人们认为医疗保健应该是私人的, 它应该进入市场, and yet we have lots and lots of experience now showing marketplace doesn't make it more affordable, 这并没有降低成本, 这并没有使它更容易被接受. 所以大发娱乐正朝着正确的方向前进, 我认为, with what they're trying to do with the ACA and we're trying to do here in Utah with some Medicaid expansion if the governor is successful, 但大发娱乐还有很长的路要走.
面试官: What do you think the three biggest challenges are to overcome in the health care arena that we face right now?
Dr. Sundwall: 其成本, 主要是, its universal access which the ACA or the ObamaCare tried to get out by having it a mandate that people have insurance. And so I would 说 access to care, it would be cost of care, and how much care do we consume.
大发娱乐的一个会议是如何照顾老年人口. It's just a huge challenge for us when we have about 70% of health care costs are spent in the last six months of life. 现在，请原谅我说的细节. The point I'm making is we spend way too much for what seems like futile care, 并没有真正延长护理质量，只是几个月而已.
面试官: 不能延长生活质量. 在那个时候，一切都是为了让人活下去.
Dr. Sundwall: 有人说，大发娱乐推迟了死亡，而不是延续生命.
面试官: 这很有趣.
Dr. Sundwall: 大发娱乐都会死，这是件大事. I just had a patient this week who I'm appalled that he's an 86-years-old from England, 最近移民到大发娱乐和他的孩子们在一起, 他和他80多岁的妻子. 他们发现了大发娱乐其中一个很好的大型医疗中心. He had an aortic aneurysm and they operated on him at 86 when he was already anemic, 他已经有糖尿病了, 他有慢性阻塞性肺病, 以及他们为什么要冒这个险, 我不知道, 但它一定花费了很多, 几千美元. 由于麻醉，他现在精神错乱. 他神志不清，住在大发娱乐医院的精神病院, 就因为他的困惑这完全和他的手术有关. 不管怎样，这很不幸. 他的生活质量非常非常差，但他仍然和大发娱乐在一起. 我想这就是大发娱乐的目标. 我不明白.
面试官: 是的. 这些都是很难回答的问题.
Dr. Sundwall: 是的.
面试官: You've said, and it's been said, that we have kind of a strange dichotomy in the United States. 大发娱乐有最好的技术和医学, yet when you look at how we rank among the developed nations in regard to health status, 大发娱乐42. 大发娱乐花的钱比任何人都多. 大发娱乐有比别人更好的东西，但大发娱乐并没有大发娱乐提供更好的东西. 为什么?
Dr. Sundwall: 好吧, like I 说, that has grown up since Medicare and Medicaid were passed in 1965. 华盛顿的卫生经济学家林恩·埃斯里奇说, 谁是卡特总统的行政管理和预算办公室的负责人, 说得比我听过的任何人都好. 他说：“医疗保险和医疗补助法案的通过是一个催化剂. We're shifting more money from one sector of an economy to another than has ever happened in the history of the world."
So now can you imagine just 50 years later we're now spending three trillion dollars on health care related services. That means that there's a whole lot of people doing very well about off of health care, 即服务的大发娱乐提供者, 无论你是医院还是医生, 医疗器械制造商, 制药公司, there's just a whole lot of people that do well because we've shifted all these public money into health care and the private insurers followed suit with the levels of what they would pay.
所以这将是一个挑战. 大发娱乐要想调整成本，就得让某些人掏腰包. 大发娱乐必须重新分配这笔钱. 大发娱乐应该加大对公共卫生的投入, 预防医学, 这些东西首先可以预防疾病, 而不仅仅是给一个86岁的老人修复腹主动脉瘤. And I'm always reluctant to cite an example because if it were me or a grandfather or maybe I'd want it done, 但你可以看出这有多难. 大发娱乐想要的是大发娱乐想要的，而不是大发娱乐能负担得起的.
面试官: 这几乎是GDP的五分之一，医疗保健支出.
Dr. Sundwall: 是的.
面试官: 这是如何逆转的呢? 那是一大笔钱.
Dr. Sundwall: 好吧, 这是大发娱乐面临的挑战, and I for one don't think it can happen voluntarily because meaning for all the best efforts of, 说, The University Hospital here to do more efficient services or to do things more appropriately, 不要做复制. 这些只是边缘的修剪. The only way to probably get a handle on this would be as in other countries where they have global budgets where they 说, “这是大发娱乐将在医疗保健上花费的钱. 活在其中. 那就这样吧.“这当然会带来一些不便. 这导致一些护理延误，但这是他们能负担得起的.
I mean, it is embarrassing, isn't it, when countries spend half as much as we do have better health? 所以数据是有偏差的，因为大发娱乐没有覆盖所有人. So our bad outcomes relate to the fact that we have still several million people that don't have health insurance or access to care with they need it. 这就是把大发娱乐拉下来的原因. 但你是对的，大发娱乐的高科技是最好的.
面试官: 为什么 is it so important making sure that we give people that don't have access to health care access?
Dr. Sundwall: 你知道, 我认为 any economist or someone that knows this information believes that if everyone is covered it means that you don't have the degree of uncompensated care. People will get care sooner and more appropriately and in the right setting if they have health insurance. We've shown through so many studies that having health insurance certainly relates to health and that makes sense. 然而, one of our state legislators said it's a bad idea because 然后 they'll go to the hospital and hospitals are dangerous places. 我认为这是一个非常荒谬的论点.
我给你们举个例子. I'm not bragging, but I've been fortunate to get to be 73-years-old and never been hospitalized. 我没有慢性病, 我没有糖尿病，也没有高血压, 我很感激我的健康. But my employers over the decades of my life have been paying my health insurance so I float all boats. 像我这样的人一直在为其他人需要的照顾买单, 如果每个人都有保险, you'd have a better pool to cover those people who are currently not covered and that means they'd likely be healthier and not be caught having this costly illnesses when they need medical care that they've delayed or put off for a long time. 等他们明白了, it costs a lot and maybe they've been getting episodic care in emergency rooms. 这不是很傻吗？? 你感冒了，要付1000美元? 这是不对的.
面试官: 是的. 现在是预防加治疗的时候了. 保持人们的健康, 然后 they don't get those diseases and those conditions that cost a lot of money, 然后.
Dr. Sundwall: 不要因此而生病. 也许他们可以得到更早的治疗，因此更合适.
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