QA問答：美國人真的會因為擔心隨后產(chǎn)生的賬單而避免去醫(yī)院，即使在嚴重的情況下也是如此嗎？

Stephen Samuel
Let me explain this from the north side of the border:

讓我從邊境的北邊(即加拿大--譯者注)來解釋一下：

Science fiction convention in Vancouver, BC. We have the pool area all to ourselves. Paul (US American) falls and hits his head on a heater. oops!

在加拿大不列顛哥倫比亞省溫哥華舉行的科幻大會上。我們獨享了泳池區(qū)域。保羅（美國人）摔倒并撞到了加熱器上。哎呀！

For us Canadians, the next step is obvious. Head trauma -> hospital visit. It’s not an extremely high probability, but an untreated concussion can sometimes be deadly. Paul freaks out at the suggestion. For us Canadians, this counter-intuitive reaction is a possible sign that he’s suffered a concussion. His wife eventually explains that, the last time he went to a hospital with a headache, he left with the same headache and a $20,000 second mortgage to pay the hospital bill. Our astonishment shifted from his extreme reaction to the reason for his extreme reaction.

對我們加拿大人來說，下一步是顯而易見的。頭部創(chuàng)傷 -> 去醫(yī)院。雖然不是極大概率，但未經(jīng)治療的腦震蕩有時可能是致命的。保羅對這個建議感到恐慌。對我們加拿大人來說，這種反直覺的反應可能是他遭受了腦震蕩的跡象。他的妻子最終解釋說，上次他因為頭痛去醫(yī)院，結果帶著同樣的頭痛和一筆2萬美元的二次抵押貸款來支付醫(yī)院賬單離開了。我們的驚訝從他極端的反應轉移到了他極端反應的原因。

It takes us about an hour to calm him down and convince him that Canadian hospitals are nowhere near as predatory as the US system. We finally take him to a hospital. The admitting nurse, on finding out that he’s not a Canadian resident asks for a credit card to pay for the treatment. Paul freaks out again. While others calm him down, I ask a few questions and am quickly able to explain that the cost is a $600 flat rate — whether he spends 1 hour in observation or 2 weeks in intensive care. He calms down again.

我們花了大約一個小時才讓他平靜下來，并說服他加拿大的醫(yī)院遠沒有美國醫(yī)療體系那么掠奪性。我們最終帶他去了醫(yī)院。接待的護士發(fā)現(xiàn)他不是加拿大居民后，要求用信用卡支付治療費用。保羅再次驚慌失措。當其他人安撫他時，我問了幾個問題，并很快解釋清楚費用是600加元的固定費率——無論他是在觀察室待1小時還是在重癥監(jiān)護室待2周。他再次平靜下來。

Knowing that the costs are well bounded, he OK’s his wife handing over the credit card, the security guards (who were worried about his hysterical reaction) calm down and go back to their normal posts. We wait about an hour or two for him to be examined … mostly waiting for an observation period, and we finally go back to the hotel.

得知費用是有限的，他同意妻子交出信用卡，保安們（原本擔心他會歇斯底里）也冷靜下來，回到了各自的崗位。我們等了一兩個小時讓他接受檢查……主要是等待觀察期結束，最后我們終于回到了酒店。

That was my first visceral experience of just how horrifying the US health care system is for people who have to live inside it. Other than the top 10% or so, most Americans have no idea just how soothing it is to know that you can visit the nearest hospital, etc., to have a medical issue looked at without worrying about what effect it will have on your budget.

那是我第一次切身感受到美國醫(yī)療體系對于必須生活在其中的人來說是多么可怕。除了大約前10%的人，大多數(shù)美國人并不知道能夠去最近的醫(yī)院等地方看醫(yī)生而不必擔心它會對你的預算產(chǎn)生什么影響是多么令人安心。

… and I really do mean nearest. Your ‘out of network’ issues are yet another layer of insanity that most Canadians can barely wrap our brains around.

……而且我真的是指最近的。你們的‘網(wǎng)絡外’問題又是另一層瘋狂，大多數(shù)加拿大人幾乎無法理解。

I don’t know how you Americans live with your system. It’s barbaric.

我不知道你們美國人是怎么忍受你們的制度的。這太野蠻了。

I guess the bigger problem is too many of you don’t live because of that system.

我猜更大的問題是你們中有太多人因為那個系統(tǒng)而無法生活。

Tara Martel
In my job I often have to host one of my “opposite numbers” from the US and one such person was in the shape of “Mary” (name changed to prorect the innoccent) and one day she was working in the office and I noticed she could barely move her left arm. I asked her what happened and eventually I got it out of her that she had slipped getting off the bus and landed on it the day before. I asked the obvious question about hospital.

在我的工作中，我經(jīng)常需要接待來自美國的“對應人員”，其中一位名叫“瑪麗”（為保護無辜者，名字已更改）。有一天，她在辦公室工作時，我注意到她幾乎無法移動左臂。我問她發(fā)生了什么事，最終她告訴我前一天下車時滑倒，摔在了左臂上。我問了關于醫(yī)院的顯而易見的問題。

I sa a look of horror on her face and she blurted out that she would be “out of network”. So I told her a little white lie, I said that our “firm” would pick up the tab and she wouldn’t even have to pay a “copay”.

我看到她臉上露出驚恐的表情，她脫口而出她會“不在網(wǎng)絡內”。所以我撒了個小謊，我說我們的“公司”會支付費用，她甚至不需要支付“共付額”。

So an ambulance was called and it was confirmed that she had broken her arm in two places. At the hospital she was looking around wide eyed. She was looking for somewhere to pay and couldn’t find it. As we were walking through to Radiology, we passed the end of a corridor that had a sign pointing towards the cashier. She seemed to be reassured by this that people did pay for treatment.

于是叫了救護車，確認她的手臂有兩處骨折。在醫(yī)院里，她睜大眼睛四處張望。她在尋找支付的地方，但沒有找到。當我們走向放射科時，經(jīng)過走廊盡頭，那里有一個指向收銀臺的標志。她似乎因此感到安心，知道人們確實需要支付治療費用。

After her xray and plaster cast she told me she wanted to swing by the cashier just to check that the bill was taken care of.

在她做完X光和打上石膏后，她告訴我她想順便去收銀臺確認一下賬單是否已經(jīng)處理好了。

“Excuse me,” she said, “but I’ve just been treated for a broken ar and my friend said its been taken care of?”

“打擾一下，”她說，“我剛剛因為手臂骨折接受了治療，我朋友說已經(jīng)處理好了？”

Being a London hospital he was used to Americans and he said “don’t worry, no one pays for emergency treatment at this hospital,”

作為一家倫敦醫(yī)院，他已經(jīng)習慣了美國人，他說：“別擔心，在這家醫(yī)院沒有人需要為急診治療付費?！?br />
I bundled her out before she could request it in writing!

在她提出書面請求之前，我就把她趕了出去！

She did say afterwards that she had heard that treatment is free at point of need but had always been lead to believe that there was a catch. She had been told that NHS hospitals were old and damp and only the private hspitals were clean and modern so she had genuinely believed that she was in a private hospital. She genuinely thought that they’d find a way to bill her.

她后來確實說過，她聽說在需要的時候治療是免費的，但她一直認為這其中一定有貓膩。她被告知NHS醫(yī)院又舊又潮濕，只有私立醫(yī)院才是干凈和現(xiàn)代的，所以她真的以為自己是在私立醫(yī)院。她真的以為他們會想辦法向她收費。

William Brixius
Absolutely yes. I’ve been in Canada just shy of 8 years now and I still retain the Murkan habit of avoiding the doc at all costs, though I am slowly getting better about it. It’s an absolute trip at the clinic my family doc’s attached to — the reception desk is entirely bypassed on the way to the exit from the exam rooms. As in it isn’t even visible. STILL feels like I’m sneaking out without paying, every time.

絕對是的。我在加拿大已經(jīng)快8年了，但我仍然保持著美國人那種盡量避免看醫(yī)生的習慣，盡管我正在慢慢改善。我家庭醫(yī)生所在的診所簡直讓人難以置信——從檢查室到出口的路上完全繞過了接待臺。也就是說，接待臺甚至都看不見。每次還是感覺像是沒付錢就偷偷溜出去一樣。

I grew up solidly middle class stateside, too, so it’s not just a poverty thing. I had insurance, but copays and this and that and the other thing add up. Went to the doc as a kid no problem, but once it was just me the only time I actively went to the doc was during grad school, when non-specialist services at the university clinic were already covered by my surprisingly reasonable basically socialized insurance through said university. Don’t get me started on the times I needed a specialist…massive wait for zero help and a massive bill for that nothing. Screw privatized healthcare, it’s pure evil.

我在美國也是在中產(chǎn)階級家庭中長大的，所以這不僅僅是貧困問題。我有保險，但自付費用和各種雜項加起來也不少。小時候去看醫(yī)生沒問題，但一旦獨立后，我唯一主動去看醫(yī)生的時候是在研究生期間，那時大學診所的非?？品找呀?jīng)通過那所大學的基本上社會化且出奇合理的保險覆蓋了。別提我需要?？漆t(yī)生的時候了……漫長的等待換來的卻是零幫助，還要為這種無用的服務支付巨額賬單。私有化的醫(yī)療體系真是純粹的邪惡。

Myra Scott
My college-age son called me one day from his apartment and said he couldn’t breathe. He didn’t know what to do, he was gasping for air. He thought it was a heart attack.

我大學年齡的兒子有一天從他的公寓打電話給我，說他無法呼吸。他不知道該怎么辦，他正在喘不過氣來。他以為這是心臟病發(fā)作。

I headed for the car while talking him through some relaxation techniques. Told him I was on the way and would be there in 10 minutes.

我一邊向他講解一些放松技巧，一邊朝汽車走去。告訴他我正在路上，10分鐘后就能到。

He called 911 while I was enroute. When I got there, they were loading him into an ambulance. I hopped in next to him and off we went to the hospital where - after 5 hours because it was a slow day- he was basically diagnosed with anxiety.

他在我前往的途中撥打了911。當我到達時，他們正把他抬上救護車。我跳上車坐在他旁邊，然后我們去了醫(yī)院——因為那天很慢，所以等了5個小時——他基本上被診斷為焦慮癥。

I work for an insurance company. I have company insurance that covers him.

我在一家保險公司工作。我有公司保險，這份保險也涵蓋了他。

We have a $4500 deductible per person and a max $10,000 out-of-pocket deductible for the family… so before catastrophic coverage actually kicks in and pays anything, I have to spend $10,000.

我們每個人的免賠額是4500美元，家庭最高自付免賠額是10000美元……所以在災難性保險開始支付任何費用之前，我必須先花費10000美元。

And since the ultimate diagnosis was not considered life-threatening, a lot of the treatment he was given was denied- so I pay for it, but it doesn’t count against that $10K out of pocket. Nearly $1000 alone for the ambulance ride.

由于最終的診斷并不被視為危及生命，他所接受的許多治療都被拒絕了——所以我支付了費用，但這不計入那1萬美元的自付費用中。僅救護車費用就將近1000美元。

This isn’t even a story of tragedy as we were lucky his symptoms were treatable. It’s a story about how a health situation can wipe out any available funds you have and put you into debt simply by having a health emergency.

這甚至不是一個悲劇的故事，因為我們很幸運他的癥狀是可以治療的。這是一個關于健康問題如何耗盡你所有可用資金，并僅僅因為一次健康緊急情況就讓你陷入債務的故事。

I have the most reasonable insurance a regular person can get, straight from my employer. I know how the system works.

我有普通人能得到的最合理的保險，直接來自我的雇主。我了解這個系統(tǒng)的運作方式。

But when your child is terrified and feels like he’s dying, you go get someone to look at it. Now. And the system makes money.

但當你的孩子感到極度恐懼，感覺像是要死了的時候，你會立即去找人來檢查?，F(xiàn)在。而這個系統(tǒng)就在賺錢。

Not just for the insurance company- everyone seems to give a pass to medical facilities and providers who charge 1000 times more than what they paid for a wrapping or an aspirin.

不僅僅是保險公司——似乎每個人都對醫(yī)療設施和提供者網(wǎng)開一面，他們收取的費用比他們?yōu)橐粔K繃帶或一片阿司匹林支付的費用高出1000倍。

Hospitals are profit centers. Doctor’s practices are profit centers. Emergency transportation is a profit center. Labs are profit centers. Every single thing in our medical system is owned by shareholders and investors. You know why? Because it’s a no-lose investment.

醫(yī)院是盈利中心。醫(yī)生的診所是盈利中心。緊急運輸是盈利中心。實驗室是盈利中心。我們醫(yī)療系統(tǒng)中的每一樣東西都由股東和投資者擁有。你知道為什么嗎？因為這是一項穩(wěn)賺不賠的投資。

People will pay $20 for a Tylenol; because they have no choice.

人們會花20美元買泰諾，因為他們別無選擇。

People will call an ambulance; because they have no choice.

人們會叫救護車，因為他們別無選擇。

People will go to the emergency room when they have an emergency; because they have no choice.

人們在緊急情況下會去急診室；因為他們別無選擇。

It’s a monopoly that has no choice but to pay dividends to investors- maybe over time, maybe on payment plans, but they will chase that blood money until they get it.

這是一個壟斷企業(yè)，它別無選擇，只能向投資者支付股息——可能是隨著時間的推移，也可能是通過分期付款計劃，但他們將追逐那筆血汗錢，直到他們得到它。

We sure do!

我們當然會！

I pay more than $1000 a month for “good insurance, and last month I fell. I knew something was wrong and instead of going to the ER, I went to urgent care because it would be so much cheaper.

我每月支付超過1000美元購買“優(yōu)質保險”，上個月我摔倒了。我知道有些不對勁，但沒有去急診室，而是去了緊急護理中心，因為那樣會便宜很多。

It almost killed me.

這幾乎要了我的命。

You see, I had broken three ribs and punctured a lung. I was bleeding into my chest cavity and the longer I waited to see the cheap doctor, I was losing my ability to breathe. At one point a lady sat next to me. She took one look at me and screamed at the front desk to call an ambulance. I told them it would cost too much and I would drive myself.

你看，我斷了三根肋骨，還刺穿了肺。我的胸腔內出血，而我等待看便宜醫(yī)生的時間越長，我的呼吸能力就越弱。有一次，一位女士坐在我旁邊。她看了我一眼，就對著前臺尖叫著要叫救護車。我告訴他們那太貴了，我會自己開車去。

Luckily for me, they stopped me from driving and the ambulance soon arrived.

幸運的是，他們阻止了我繼續(xù)開車，救護車很快就到了。

I stayed in the hospital for 3 days and demanded to be released because I couldn’t afford to be there any longer. I was released AMA and I got lucky that I had someone at home to care for me. It has taken weeks for me to be able to take a breath without pain, and while my doctor wanted to see me at the two-week mark, I waited until 4 weeks to see her.

我在醫(yī)院住了三天，并要求出院，因為我再也負擔不起住院費用了。我是在醫(yī)生不同意的情況下出院的，幸運的是家里有人照顧我。我花了幾個星期才能無痛地呼吸，雖然醫(yī)生希望我在兩周后復診，但我等到四周后才去見她。

I am now waiting for the bills to arrive. I know that my deductible for the year is $17,000 and that will be what I will have to pay before the full insurance kicks in, but I will STILL have more deductibles to pay!!

我現(xiàn)在正在等待賬單的到來。我知道我今年的免賠額是17,000美元，這是我在全額保險生效之前必須支付的金額，但我仍然需要支付更多的免賠額??！

Our system is BROKEN!! The MAIN reason people file for bankruptcy is medical bills, and we are supposedly a first-world nation!!!!

我們的系統(tǒng)崩潰了??！人們申請破產(chǎn)的主要原因是醫(yī)療賬單，而我們竟然是一個所謂的第一世界國家?。。。?br />
People are so damn worried about paying for everyone to get medical care that they would rather go bankrupt than pay LESS than we do now for actual care! They seem to forget that they are already paying for roads, schools, first responders and so much more, but heaven forbid they pay for medical!

人們非常擔心為每個人支付醫(yī)療費用，以至于他們寧愿破產(chǎn)，也不愿支付比我們現(xiàn)在實際支付的更少的費用！他們似乎忘記了他們已經(jīng)為道路、學校、急救人員等支付了費用，但天哪，他們竟然不愿意為醫(yī)療支付費用！

It would be CHEAPER FOR EVERYONE!!!

這對每個人來說都會更便宜！?。?br />
PLUS our politicians are in the pockets of the insurance companies who will lose billions if we were to have universal healthcare. So, we continue to see the decline in our health, die earlier, and lose mothers during childbirth at a rate higher than some third-world nations, and all people can think of is “Well at least I didn’t pay for someone else to live”.

此外，我們的政客被保險公司收買，如果我們實行全民醫(yī)保，這些公司將損失數(shù)十億美元。因此，我們繼續(xù)看到健康狀況的下降，壽命縮短，母親在分娩時的死亡率高于一些第三世界國家，而所有人能想到的只是‘至少我沒有為別人的生命買單’。

Absolute stupidity!

絕對的愚蠢！

The other day, I was at a supermarket. An elderly gentleman was lying on the floor, face down, and didn’t respond to voices or sounds. I and another guy stood by him, not sure what to do. I asked the other guy, “Should we call an ambulance for him?” The guy said, “Maybe we should wait and see if he gets up on his own. We don’t know if he has insurance.”

前幾天，我在一家超市里。一位老先生臉朝下躺在地上，對聲音或喊叫沒有反應。我和另一個人站在他旁邊，不確定該怎么做。我問那個人：“我們應該為他叫救護車嗎？”那個人說：“也許我們應該等等，看看他能不能自己起來。我們不知道他有沒有保險。”

That’s what you need to know about American health care. We saw a person needing medical help, but we were hesitant about getting him help because we didn’t know if this potentially life-saving help might bankrupt him. In the US, around 650,000 people file for bankruptcy each year due to medical bills. This is more than 60% of all personal bankruptcies.

這就是你需要了解的美國醫(yī)療保健。我們看到一個人需要醫(yī)療幫助，但我們猶豫是否要幫助他，因為我們不知道這種可能救命的幫助是否會讓他破產(chǎn)。在美國，每年大約有65萬人因醫(yī)療賬單而申請破產(chǎn)。這占所有個人破產(chǎn)的60%以上。

Eventually, the store clerk called an ambulance; I assumed, due to liability issues, that they were obligated to call for help.

最終，店員叫了救護車；我猜想，由于責任問題，他們有義務呼叫幫助。

I watched the paramedics move the guy into an ambulance. I hope he’s alright and he has insurance to pay for the ER visit.

我看著醫(yī)護人員將那個人抬上了救護車。我希望他沒事，并且他有保險來支付急診室的費用。

Susan Shepherd
This is why my family has a ‘tradition’ of driving themselves to the hospital for chest pains…we can't afford the ambulance.

這就是為什么我家有一個‘傳統(tǒng)’，當有人胸痛時，自己開車去醫(yī)院……我們付不起救護車的費用。

Why I get admitted to a hospital at almost midnight for symptoms that started shortly after noon. When the attending asked why I had waited sk long to seek medical assistance, I said I had to finish my work shift, get paid, & then locate someone who could drive me to the hospital (I was unable to drive myself by that point). I couldn't afford the ambulance.

為什么我?guī)缀踉谖缫箷r分因中午后不久出現(xiàn)的癥狀而入院。當主治醫(yī)生問我為什么等了這么久才尋求醫(yī)療幫助時，我說我必須完成我的工作班次，拿到工資，然后找到一個可以開車送我去醫(yī)院的人（那時我已經(jīng)無法自己開車了）。我負擔不起救護車的費用。

I left the hospital with no diagnosis, just the knowledge that I ‘probably’ wasn't contagious, because I couldn't afford to remain in hospital any longer.

我離開了醫(yī)院，沒有診斷結果，只知道我‘可能’沒有傳染性，因為我無法承擔繼續(xù)住院的費用。

It's why one family member bought a used wheelchair: they couldn't afford the knee replacement they desperately needed and was trying to hold out-in excruciating pain- until they would be old enough to qualify for Medicare.

這就是為什么一個家庭成員買了一輛二手輪椅：他們負擔不起他們迫切需要的膝關節(jié)置換手術，并且試圖在極度痛苦中堅持，直到他們達到有資格享受醫(yī)療保險的年齡。

It's why I'm far more accustomed to helping someone put their dislocated shoulders back into place.

這就是為什么我更習慣于幫助別人把脫臼的肩膀復位。

Most Healthcare options in the USA are a joke.

美國的大多數(shù)醫(yī)療保健選擇都是笑話。

I know a lot of people will say, ‘X country has Universal Healthcare, & it has [X] problems! It's not perfect!

我知道很多人會說，‘X國家有全民醫(yī)療保健，但它有[X]問題！它并不完美！’

They're right. It's not perfect. However, it's better than what most of the USA has accessible.

他們是對的。它并不完美。然而，它比美國大多數(shù)地方所能提供的要好。

It's astounding how many politicians can't seem to grasp that a HEALTHY population is a PRODUCTIVE population- & that it's much easier to keep someone healthy than to care for them later.

令人震驚的是，許多政客似乎無法理解一個健康的人口就是有生產(chǎn)力的人口——而且保持一個人的健康比以后照顧他們要容易得多。

Then again, considering how many of the USA's politicians get paid (by one means or another) by the private health insurance companies & pharmaceutical companies, & how little they seem to care about their constituents…maybe it's not surprising at all.

再次考慮到美國有多少政客通過某種方式從私人健康保險公司和制藥公司那里獲得報酬，以及他們似乎多么不關心他們的選民……也許這根本不足為奇。

Aurolyn Luykx
Absolutely. A few months ago I fainted at a friend’s house a few hours after giving blood. My friend, alarmed, called the EMTs. Even though I was only at the ER about an hour (not admitted), the bill was nearly $15,000. My insurance paid 90% of that but now I have a bill for $1500 because I fainted. I told my friend that if that happens again, don’t call the EMTs.

絕對是這樣。幾個月前，我在獻血后幾小時在朋友家暈倒了。我的朋友很驚慌，叫了急救人員。盡管我在急診室只待了大約一個小時（沒有被收治），賬單卻接近15,000美元。我的保險支付了其中的90%，但現(xiàn)在我有一張1,500美元的賬單，因為我暈倒了。我告訴我的朋友，如果這種情況再次發(fā)生，不要叫急救人員。

I once observed a GOP Congressman who was holding a town hall meeting (keep in mind the audience was overwhelmingly made up of his SUPPORTERS). At one point a constituent asked him a question about health care costs, and he replied “No one dies in the U.S. from lack of access to health care.” The crowd ROARED in indignation; they knew from hard experience that that statement was false.

我曾目睹一位共和黨國會議員在舉行市政廳會議（請記住，觀眾絕大多數(shù)是他的支持者）。有一次，一位選民向他提出了一個關于醫(yī)療費用的問題，他回答說：“在美國，沒有人會因為無法獲得醫(yī)療服務而死亡?！比巳簯嵟嘏叵饋恚凰麄儚挠H身經(jīng)歷中知道，這種說法是錯誤的。

For decades Americans have been speculating about why people in ALL other comparably wealthy countries have longer lifespans. Could it be the effects of red wine, walkable cities, longer vacations, the Mediterranean diet??? Turns out it was access to health care all along. Insurance company lobbies own both parties, though Biden has made some strides in limiting their extortionary practices. The U.S. won’t get universal health care until the people demand it.

幾十年來，美國人一直在猜測為什么所有其他相對富裕國家的人們壽命更長。是因為紅酒的影響、可步行的城市、更長的假期、地中海飲食嗎？結果發(fā)現(xiàn)，一直以來都是醫(yī)療保健的獲取問題。保險公司的游說團體控制著兩黨，盡管拜登在限制他們的勒索行為方面取得了一些進展。美國不會實現(xiàn)全民醫(yī)療保健，直到人民要求它。

Bart Crunk
My kid had appendicitis, and needed surgery. I live in a rural area with small hospitals. There was only one surgical team in that particular hospital, and as they were in surgery, it would have been 12 hours before they could operate on my son. As he was VERY thin, getting the pain meds regulated was very difficult.

我的孩子得了闌尾炎，需要手術。我住在一個農(nóng)村地區(qū)，那里只有小型醫(yī)院。那家醫(yī)院只有一個手術團隊，而他們當時正在手術中，需要12個小時后才能為我的兒子進行手術。由于他非常瘦，調節(jié)止痛藥非常困難。

They decided to transfer him to another hospital by ambulance. The bill for transporting him was $1,400, and insurance didn’t cover it as it wasn’t deemed “medically necessary”. I suppose he was just supposed to be in pain for 12 hours.

他們決定用救護車將他轉移到另一家醫(yī)院。運送他的費用是1400美元，而保險沒有覆蓋這筆費用，因為這不被認為是“醫(yī)療必要的”。我想他可能只是應該忍受12小時的痛苦。

My wife ran into a similar situation when her gall bladder decided to make its escape. It was during Covid so finding a surgical team at any nearby hospital took a while. They were going to transfer her to another hospital by ambulance, so she discharged herself against medical orders. I had concerns that insurance might not cover her ER visit as we left against orders, but they did. I drove her to another hospital to avoid another ambulance charge.

我妻子也遇到了類似的情況，當時她的膽囊出了問題。那是在新冠疫情期間，所以在附近的醫(yī)院找到手術團隊花了一些時間。他們打算用救護車將她轉移到另一家醫(yī)院，所以她違背了醫(yī)生的指示自行出院了。我擔心保險公司可能不會支付我們違背指示離開后的急診費用，但他們還是支付了。我開車送她去了另一家醫(yī)院，以避免再次產(chǎn)生救護車費用。

And that’s what healthcare is like in the US.

這就是美國的醫(yī)療保健情況。

When I was a kid I was getting sick at school everyday. Stomach pain, vomiting, just sick. I managed to hide it from my dad for almost a week as I knew it would anger him. Sick kids and Dr visits cost money and caused problems he didn’t wish to deal with. Finally I was too sick to get off the sofa and go to my bed. I cried and begged Mom to stay with me as I knew in my heart I was going to die and I was scared. Dad finally noticed and yelled at Mom for not doing something about it. The called the ER who told us to get there immediately. So after a middle of the night drive from our rented farmhouse, in a blizzard, to the hospital in the nearest town, we made it to the ER. I went into convulsions on the way up to the OR. Ruptured appendix with peritonitis. Ended up on the hospital for 3 weeks. All that could have been avoided if heath care wasn’t so expensive. Btw Dad had to file bankruptcy after that. So how is US health care better again?

當我還是個孩子的時候，我每天都在學校生病。胃痛、嘔吐，就是生病了。我設法瞞了爸爸將近一個星期，因為我知道這會讓他生氣。生病的孩子和看醫(yī)生要花錢，還會帶來他不想處理的問題。最后，我病得太重了，無法從沙發(fā)上起來去床上。我哭著求媽媽陪著我，因為我知道我快要死了，我很害怕。爸爸終于注意到了，并責罵媽媽沒有采取行動。他們打電話給急診室，急診室告訴我們立即過去。于是，在深夜，我們從租住的農(nóng)舍出發(fā)，冒著暴風雪，開車到最近城鎮(zhèn)的醫(yī)院，終于到了急診室。我在去手術室的路上開始抽搐。闌尾破裂并發(fā)腹膜炎。最終在醫(yī)院住了三個星期。如果醫(yī)療費用不那么昂貴，這一切本可以避免。順便說一下，爸爸之后不得不申請破產(chǎn)。那么，美國的醫(yī)療保健到底好在哪呢？

Heather Scott
I have cancer. I went to one of those free screenings. They referred me to an oncologist who takes patients without insurance. The receptionist advised just the consult would be $350, if they decided to run any tests, etc. I would be billed separately. If I had a bill it would need to be paid in full before my next visit or any treatments could start. Treatments would need to be paid for in advance and depending on the treatment I could expect to pay anywhere from $20k-100k. There's a ton of other costs and the nearest treatment center is 9 and a half hours away, meaning I would need to find somewhere to stay nearby for several weeks. I don't have it like that. Instead, I'm working on paying for my final costs since it's slightly cheaper and doable and one less thing for my family to deal with after.

我得了癌癥。我去了一次免費篩查。他們把我轉診給了一位接收無保險患者的腫瘤科醫(yī)生。接待員建議，僅咨詢費用就要350美元，如果他們決定進行任何測試等，我會被單獨收費。如果有賬單，我需要在下次就診或開始任何治療之前全額支付。治療需要提前支付，根據(jù)治療的不同，我預計需要支付2萬到10萬美元。還有很多其他費用，而且最近的治療中心要9個半小時的車程，這意味著我需要在附近找個地方住上幾周。我沒有那樣的條件。相反，我正在努力支付我的最終費用，因為這稍微便宜一些，而且可行，也能讓我的家人在之后少處理一件事。

Max Cady
My health insurance is $1K/month with a $7K deductible for an 80/20 coverage. I can only use a specific hospital system. A couple years ago, post knee-replacement surgery, I developed an infection. In a matter of minutes, I went from limping to unable to walk, had shortness of breath and irregular heartbeat. We had to call an ambulance. We requested they take me to an in network hospital- Sorry, you go to closest hospital.

我的健康保險每月1000美元，自付額為7000美元，保險比例為80/20。我只能使用特定的醫(yī)院系統(tǒng)。幾年前，在膝蓋置換手術后，我感染了。在幾分鐘內，我從跛行變成了無法行走，呼吸急促，心跳不規(guī)律。我們不得不叫救護車。我們請求他們帶我去網(wǎng)絡內的醫(yī)院——抱歉，你得去最近的醫(yī)院。

I was admitted after a 15 hour stint in the ED. I was inpatient at this unit for five days. The insurance company refused to cover anything as 1) their doctor did not classify my ED treatment as emergent. 2) My inpatient care was out of network. ED bill for 15 hours, pain meds,xray/ct, & antibiotics-$18,000. The inpatient total was over$120K. I had to fight with doctors, hospital admin, insurance companies and their doctors over an 8 month period to get this settled. I was threaten with collection agencies and legal action.

我在急診室待了15個小時后被收治入院。我在這個病房住院了五天。保險公司拒絕支付任何費用，因為1）他們的醫(yī)生沒有將我的急診治療歸類為緊急情況。2）我的住院治療不在網(wǎng)絡內。15小時的急診賬單，包括止痛藥、X光/CT和抗生素，費用為18,000美元。住院總費用超過12萬美元。我不得不與醫(yī)生、醫(yī)院管理人員、保險公司及其醫(yī)生斗爭了8個月才解決這個問題。我收到了催收機構和法律行動的威脅。

In the end, I paid my deductible plus another $27k for treatment. All this is above the $12K I already paid for insurance. USA - the only first world country where a person can go bankrupt from medical debt!

最終，我支付了我的免賠額以及另外2.7萬美元的治療費用。所有這些都在我已經(jīng)支付的1.2萬美元保險費用之上。美國——唯一一個一個人可能因醫(yī)療債務而破產(chǎn)的發(fā)達國家！

Leah
A couple months ago, my daughter and her husband were in the US. They were brought to a restaurant by their hosts.

幾個月前，我的女兒和她的丈夫在美國。他們的主人帶他們去了一家餐廳。

At the restaurant, just in front of the door, there was a woman on the ground, who seemed to be having a seizure or something. She was foaming at the mouth and seemingly unconscious or unable to communicate. People were walking around her to get in.

在餐廳里，就在門前，地上躺著一位女士，她似乎正在發(fā)作癲癇或其他什么癥狀。她口吐白沫，看起來已經(jīng)失去意識或無法交流。人們從她身邊走過進入餐廳。

Someone decided to call 911, and some emergency services came (I don’t know which exactly). They proclaimed she needed an ambulance and to be taken to the hospital immediately.

有人決定撥打911，一些緊急服務來了（我不知道具體是哪些）。他們宣布她需要救護車，并立即被送往醫(yī)院。

Someone near her cried out- she doesn’t have insurance! So they stood up and said, “Oh, okay. Well… try to keep her hydrated.” …. and left.

她旁邊有人喊道——她沒有保險！于是他們站起來說：“哦，好吧。嗯……盡量讓她保持水分?！薄缓箅x開了。

My daughter was raised in France, so she found this shocking, and had trouble eating, seeing the woman on the ground in this state the whole time. I was raised in the US, and am quite accustomed to this. I am used to avoiding any healthcare as long as possible to avoid the cost. But for some other countries, it is completely insane.

我的女兒在法國長大，所以她對此感到震驚，并且難以進食，看到那個女人一直處于這種狀態(tài)。我在美國長大，對此已經(jīng)非常習慣了。我習慣盡可能長時間地避免任何醫(yī)療保健，以避免費用。但對于其他一些國家來說，這完全是瘋狂的。

C.S. Friedman
A couple of years ago I had just gone onto Medicare so I had good insurance for the first time in my life. Before that I had an Obamacare policy with a $6000 deductible and shitty coverage.

幾年前我剛加入醫(yī)療保險，那是我人生中第一次有了不錯的保險。在此之前，我有一份奧巴馬醫(yī)改政策的保險，免賠額高達6000美元，而且保障很差。

One day my shin seemed swollen and tender and hot. Time passed and It wasn't going away. It struck me that there was a small chance it could be a blood clot and I should have it checked out ASAP.

有一天，我的小腿似乎腫脹、疼痛且發(fā)熱。時間過去了，情況并沒有好轉。我突然想到，這有可能是血栓，應該盡快去檢查。

Went to the emergency room of the local hospital, where they told me they didn't think it was that, but they would run some tests to make sure. Some really expensive tests with complicated machines. I also had an exhaustive blood panel done. As I sat there in their clinic waiting for someone to come to draw my blood, it suddenly hit me that if this had happened two years earlier, I would be crying in that chair. The knowledge of how many thousands of dollars this trip would cost me would be overwhelming.

去了當?shù)蒯t(yī)院的急診室，他們告訴我他們認為不是那樣，但他們會做一些檢查來確認。一些非常昂貴的檢查，使用復雜的機器。我還做了一次全面的血液檢查。當我坐在他們的診所里等待有人來抽血時，我突然想到，如果這件事發(fā)生在兩年前，我會在那把椅子上哭泣。知道這次就診會花費我數(shù)千美元，這種想法會讓我感到難以承受。

A year later I had symptoms that might be a heart attack. I wasn't sure, but better safe than sorry. That required an ambulance, because they didn't want you to d tbhrive if you might be having a heart attack. That ride usually cost 1500. The best insurance I had ever been able to buy only reduced it to $500. Then there were x-rays, blood tests, EKGs, all sorts of stuff. Who knew it was so hard to be sure someone was not having a heart attack? (I wasn't).

一年后，我出現(xiàn)了可能是心臟病的癥狀。我不確定，但安全總比后悔好。這需要叫救護車，因為他們不想讓你冒險，以防你可能是心臟病發(fā)作。那次救護車通常要花費1500美元。我買過的最好的保險也只能將其減少到500美元。然后還有X光、血液檢查、心電圖等各種檢查。誰知道要確定一個人是否沒有心臟病發(fā)作這么難？（我沒有）。

Both times I asked myself if I would have come to the hospital with my old insurance. The answer in both cases was, probably not. I would have waited a little longer to see if the pain resolved on its own. Stupidest thing you can do with a heart attacking m, but that is how things work in the US. Many people who do go to the hospital have someone drive them instead of calling an ambulance, which means thy can't be tested it treated on the way. But ambulance use is not covered by most policies, and never completely covered.

兩次我都問自己，如果我有以前的保險，我是否會來醫(yī)院。兩次的答案都是，可能不會。我可能會再等一會兒，看看疼痛是否會自行消失。對于心臟病發(fā)作來說，這是最愚蠢的做法，但這就是美國的情況。許多去醫(yī)院的人都是讓別人開車送他們，而不是叫救護車，這意味著他們無法在途中接受檢查或治療。但大多數(shù)保險都不包括救護車的使用，而且從來不會完全覆蓋。

And I am not poor. For people who are, there is no choice. They will deal with wounds and sickness as long as they possibly can without help. If there is a free clinic it will require a long, stressful wait, and not with the kind of care or facilities that I experienced. And that is true even for people who have some insurance, because deductibles are often so high.

我并不貧窮。對于那些貧窮的人來說，他們別無選擇。他們會盡可能地自己處理傷口和疾病，而不尋求幫助。即使有免費診所，也需要長時間、緊張的等待，而且無法得到我所經(jīng)歷的那種護理或設施。即使對于那些有一些保險的人來說，這也是事實，因為免賠額通常很高。

Medical care is something many Americans go without for as long as they can.

醫(yī)療保健是許多美國人盡可能長時間避免的東西。

Al Klein
Some probably do.

有些人可能會。

On the night of April 2, I opened a package of hamburger patties, to have one for supper. It had been in the freezer, at -15° F, for about 14 months. By 3 AM, I felt as if I had poisoned myself, so I started drinking (soda and water) a lot.

在4月2日晚上，我打開了一包漢堡肉餅，準備吃一個作為晚餐。這包肉餅已經(jīng)在零下15華氏度的冷凍室里放了大約14個月。到了凌晨3點，我感覺自己好像中毒了，于是開始大量喝水（蘇打水和清水）。

By Sunday morning, April 6, I asked my neighbor to drive me to the ED. (I’d sooner die than get behind the wheel in that much pain.) I happen to be covered by the VA for anything Medicare doesn’t cover.

到了4月6日星期天早上，我請鄰居開車送我去急診室。（我寧愿死也不愿在那么痛的情況下開車。）我恰好有退伍軍人事務部的保險，可以覆蓋醫(yī)療保險不覆蓋的部分。

It turned out that my gall bladder had had a party, grown a deathstar stone and been shredded better than the finest pulled pork. (It took the surgeon over an hour to clean out the rot, plus the normal hour it should have taken.)

結果發(fā)現(xiàn)我的膽囊舉辦了一場派對，長出了一顆死星般的結石，并且被切得比最細的拉豬肉還要碎。（外科醫(yī)生花了一個多小時清理腐爛部分，再加上正常情況下應該花費的一個小時。）

At that point, though, I’d have gone to the ER if I had known that it would cost me $100k. (I wouldn’t be a happy camper, but I’m lucky in that I can pay that much.)

不過，如果我知道那會花掉我10萬美元，我早就去急診室了。（我不會是個快樂的露營者，但幸運的是我能付得起那么多錢。）

But a lot of Americans don’t have one week of net pay in the bank, so they ignore things until they get so serious that $100k would be cheap for what they need. Then they have to file for bankruptcy.

但是很多美國人銀行里連一周的凈收入都沒有，所以他們一直忽視問題，直到問題變得非常嚴重，以至于10萬美元對他們來說都是便宜的。然后他們不得不申請破產(chǎn)。

George Sawyer
You bet. I only go when I feel like I have no choice.

你說得對。我只有在覺得別無選擇的時候才會去。

I recently cut my hand badly. I was afraid I had cut a tendon or I would not have gone at all.

我最近嚴重割傷了手。我擔心自己割斷了肌腱，否則我根本不會去醫(yī)院。

I was driven by a friend to the emergency room. They encouraged me to go to the emergency room when I spoke of going to the far less expensive, walk-in ‘urgent care’ clinic.

一位朋友開車送我去急診室。當我提到要去費用低得多的‘緊急護理’診所時，他們鼓勵我去急診室。

I even asked the doctor who stitched up my hand if I should have gone to Urgent Care, because of the cost difference. I’m sitting on the table, bleeding, asking the doctor if I could have saved money. He said they might have sent me back to the emergency room.

我甚至問給我縫合手的醫(yī)生，我是否應該去緊急護理中心，因為費用不同。我坐在桌子上，流著血，問醫(yī)生我是否可以省點錢。他說他們可能會把我送回急診室。

It was not as bad as it looked. Only two stitches, no x-rays, no tests (just taking my temperature and blood pressure). The doctor probably spent 15 minutes total with me - he was friendly, helpful, informative, and I’m told his sewing was unusually good.

情況并沒有看起來那么糟糕。只縫了兩針，沒有拍X光片，也沒有做其他檢查（只是量了體溫和血壓）。醫(yī)生總共可能只花了15分鐘和我在一起——他友好、樂于助人、信息豐富，而且我被告知他的縫合技術異常出色。

The visit was over $2,000 US, my health insurance paid about $1,400, I had to pay a bit over $600.

這次訪問的費用超過2000美元，我的健康保險支付了大約1400美元，我不得不支付了600多美元。

In case you are wondering, I pay about $178 per month towards my health insurance, my employer pays the rest.

如果你想知道，我每月支付大約178美元的健康保險費用，其余部分由我的雇主支付。

I know two co-workers facing heavy medical bills from emergency surgery this summer.

我知道今年夏天有兩位同事因緊急手術而面臨沉重的醫(yī)療費用。

If you spend a few minutes with google, you’ll see that about 500,000 Americans declare bankruptcy each year from medical debt. It is the leading cause of bankruptcy in America.

如果你花幾分鐘時間在谷歌上搜索，你會發(fā)現(xiàn)每年大約有50萬美國人因醫(yī)療債務而宣布破產(chǎn)。這是美國破產(chǎn)的主要原因。

Alex Calet
An NHS ambulance call-handler who is a US citizen and was formerly an ambulance driver in New York said recently on British TV that in the US the job was easy, because it cost so much that people would not call an ambulance, so he and the others used to sit round playing cards between jobs. Now in the UK he says that he sees the amount of work our NHS ambulance staff have to do he will never go back. He now feels he is doing a proper job, helping people who need it. I haven’t seen the background stats, but Dr Adam Kay says in his book “Undoctored” that two-thirds of US bankruptcies have health care bills as a contributing factor and less than half of Americans could afford an unexpected medical bill of $1000, which would be lucky to cover a sprained ankle.

一位NHS救護車調度員，他是美國公民，曾擔任紐約的救護車司機，最近在英國電視上表示，在美國這份工作很容易，因為費用太高，人們不會叫救護車，所以他和同事們經(jīng)常在任務之間坐著打牌?，F(xiàn)在在英國，他說看到我們的NHS救護車工作人員必須完成的工作量，他永遠不會回去。他現(xiàn)在覺得自己在做一份真正的工作，幫助需要幫助的人。我還沒有看到背景統(tǒng)計數(shù)據(jù)，但亞當·凱醫(yī)生在他的書《Undoctored》中說，三分之二的美國破產(chǎn)案都有醫(yī)療賬單作為促成因素，不到一半的美國人能夠負擔得起1000美元的意外醫(yī)療賬單，這幸運的話可能只夠支付扭傷腳踝的費用。

Francis Vincent
 The clue is in a little known statistical fact. No other wealthy industrialized country has such a high percentage of citizens dying from conditions/complaints which could have been prevented from swift medical interventions. A direct result of a reluctance to obtain medical or pharmaceutical support because of perceived financial implications.

線索在于一個鮮為人知的統(tǒng)計事實。沒有其他富裕的工業(yè)化國家有如此高比例的公民死于本可以通過快速醫(yī)療干預預防的疾病/不適。這是因擔心財務影響而不愿尋求醫(yī)療或藥物支持的直接結果。

Edward Meeker
I won't tell you any story because every time someone asks a question like this, stories flood in. The amazing thing is that the best solution we have so far is the Affordable Care Act. It is a half ass solution to what is a major problem. A problem that almost every other industrial nation in the world has solved by creating some sort of socialized system. We need to tell these fu￠kers (insurance companies, pharma, and all the institutions) that use human suffering to make profit to just fu￠k off. When are we going to realize that the suffering from suffering is just not needed.

我不會告訴你任何故事，因為每次有人提出這樣的問題，故事就會泛濫成災。令人驚訝的是，我們目前最好的解決方案是《平價醫(yī)療法案》。這是一個對重大問題的不完全解決方案。世界上幾乎每個其他工業(yè)化國家都通過創(chuàng)建某種社會化系統(tǒng)解決了這個問題。我們需要告訴這些利用人類痛苦來牟利的混蛋（保險公司、制藥公司以及所有機構）滾蛋。我們什么時候才能意識到，痛苦帶來的痛苦是不必要的。

Bill Baldwin
Yes. My wife was in the hospital with COVID. After 2 weeks the insurance company told us if she stayed longer than that we would have to pay for the entire hospital bill ourselves. This could have easily been in the hundreds of thousands of dollars, so we had no choice but to leave over the obxtions of the doctor. Fortunately, we were able to supply oxygen at home since she has lung damage due to asthma. A week later we were forced to go to the hospital again because our at home equipment could not keep up. The copay was $3400 for the two hospital stays.

是的。我妻子因COVID住院。兩周后，保險公司告訴我們，如果她住院時間超過兩周，我們將不得不自行支付全部住院費用。這筆費用可能高達數(shù)十萬美元，所以我們別無選擇，只能不顧醫(yī)生的反對離開醫(yī)院。幸運的是，由于她因哮喘導致肺部損傷，我們能夠在家中提供氧氣。一周后，我們被迫再次去醫(yī)院，因為我們的家用設備無法跟上需求。兩次住院的自付費用是3400美元。

Joy Freeman
I hear people complaining all the time about the cost of healthcare and health insurance. If you are lucky enough to have Medicare and can afford a good Supplemental policy without deductibles you will be well covered and not need to worry about further costs. Otherwise the deductibles alone will be burdensome.

我經(jīng)常聽到人們抱怨醫(yī)療保健和醫(yī)療保險的費用。如果你有幸擁有醫(yī)療保險，并且能夠負擔得起沒有免賠額的良好補充保險，那么你將得到很好的保障，無需擔心進一步的花費。否則，僅免賠額就會成為負擔。

The United States is the only wealthy, industrialized nation that does not provide universal health care.

美國是唯一一個不提供全民醫(yī)療保健的富裕工業(yè)化國家。

Pete Cresswell
Dunno from “Serious", but I avoid ambulance calls and hospitals as much as possible.

不知道“嚴肅”是什么意思，但我盡可能避免救護車呼叫和醫(yī)院。

I actually have pretty good medical insurance by USA standards - but my fear is of being treated or transported by some out-of-network provider and waking up broke.

實際上，按照美國的標準，我有相當不錯的醫(yī)療保險——但我擔心的是被一些不在網(wǎng)絡內的醫(yī)療服務提供者治療或轉運，然后醒來發(fā)現(xiàn)自己破產(chǎn)了。

Ward Chartier
I’ve lived and worked in 6 countries on three continents. In all of them I was aware of people who postponed or skipped treatment because of out of pocket costs that would come from seeing a doctor or going to a hospital.

我在三個大洲的六個國家生活和工作過。在所有這些地方，我都意識到有人因為看醫(yī)生或去醫(yī)院需要自付費用而推遲或跳過治療。

Lorinda Morgan
Yes. I have covid right now. Last night my husband wanted to take me to the emergency room because my breathing was labored. I refused. I can't afford to both miss work AND go to the ER. So I am home. Hoping for the best.

是的。我現(xiàn)在感染了新冠病毒。昨晚我丈夫想帶我去急診室，因為我的呼吸很困難。我拒絕了。我既無法承擔誤工的損失，也無法承擔去急診室的費用。所以我在家里。希望一切順利。

Mark Rose
Even when insured, Americans may have to pay large co-pays and deductibles that can prevent them from being able to afford needed care. Often they have to decide if they are sick enough to rack up debt they can’t pay.

即使有保險，美國人可能仍需支付大額共付額和免賠額，這可能會使他們無法負擔所需的醫(yī)療。通常，他們必須決定是否病到足以承擔無法償還的債務。

Mike
No but many people do avoid taking the ambulance because of the cost .Some people find ways to sue the hospital for money . It usually worked because the hospital didn't have the time to fight the lawsuit. Now they require you to sign a waiver for any liability even before any care is done

不，但許多人因為費用問題避免叫救護車。有些人想辦法起訴醫(yī)院以獲取賠償。這通常奏效，因為醫(yī)院沒有時間應對訴訟。現(xiàn)在他們要求你在接受任何治療之前簽署一份免責協(xié)議。

The fact is American is the only first world country that doesn’t have some sort of free health care and higher education. It seems they want their citizens to be unhealthy and uneducated so they are more dependent on the government for everything.

事實是，美國是唯一一個沒有某種免費醫(yī)療和高等教育的發(fā)達國家。似乎他們希望他們的公民不健康且未受教育，以便他們在各方面更加依賴政府。

Mike Conte
Of course they do. You never know what bills will come in and you can’t fight them and expect to win. The collectors will break you. If you can’t afford to replace a $600 refrigerator are you going to risk a $10,000 charge because you broke your arm?

當然他們會。你永遠不知道會有什么賬單到來，你無法與之抗爭并期望獲勝。收債人會把你壓垮。如果你連更換一臺600美元的冰箱都負擔不起，你會因為摔斷了胳膊而冒10000美元的風險嗎？

Kathleen Jones
Yes. That is why US citizens have a lower life expectancy than similar citizens of other developed countries in Europe. They are so frightened of medical bankruptcy, choosing health over rent or feeding their families that they let small things fester or go unchecked. It is horrible that the GOP cares more about big pharma than US citizens.

是的。這就是為什么美國公民的預期壽命低于歐洲其他發(fā)達國家的類似公民。他們非常害怕醫(yī)療破產(chǎn)，選擇健康而不是支付房租或養(yǎng)家糊口，以至于讓一些小問題惡化或得不到檢查。令人震驚的是，共和黨更關心大型制藥公司而不是美國公民。

Tialisa Chapman
over a 1000 bucks for 2 stitch's you can dang well bet we avoid it. thats food for a long time, , most times its something big & that generally means food & rent go unpaid & it just cycles, then there the harassment, they even harass people in the family that have nothing to do with the patient, & they will come back AFTER YEARS to get payments. so yep we avoid it as much as possible

為了兩針就花了一千多美元，你完全可以打賭我們會盡量避免。那可是一段時間的食物錢，大多數(shù)時候都是大問題，通常意味著食物和房租無法支付，然后就陷入了惡性循環(huán)。還有騷擾，他們甚至會騷擾與病人無關的家人，而且他們會在多年后回來要錢。所以是的，我們會盡可能避免。