07. 醫保讓我們都病了 Health Care Is Making Us All Sick

THE BASIC DIFFERENCE BETWEEN the politicians’ way and my way is that I’ve actually had to do the things that politicians only talk about doing.

之間的政治家“的方式，我的方式最根本的區別是，我實際上已經不得不這樣做政治家只談做的事情。

I’ve hired thousands of employees. I’ve had to negotiate with contractors and unions. I’ve had to provide health care coverage for my workers. I know what the real costs are, I know what the problems are. I know what works and what doesn’t work.

我已經聘請了數千名員工。我已經與承包商和工會進行談判。我已經為我的員工提供醫療保險。我知道什麼是真正的成本，我知道問題是什麼。我知道什麼行得通，什麼行不通。

Most important, I know where the waste is and how to provide good medical coverage at reasonable costs.

最重要的是，我知道那裡的浪費，以及如何以合理的成本提供良好的醫療保障。

Politicians don’t want to hear the truth, nor do they want to tell you the truth. They’re total hypocrites, especially when campaigning for reelection. They love to take to the stump and condemn “reckless government spending” and “government waste.” And yet virtually every bill passed by Congress is loaded with special goodies for their districts.

政治家不希望聽到真理，也沒有想告訴你真相。他們是偽君子總量，爭取連任競選時尤其如此。他們喜歡把樹樁和譴責“不計後果的政府開支”和“政府浪費”。然而，幾乎在國會通過的每一條法案載有其區的特殊東西。

We call this the “pork barrel” approach, which is a real disservice to pigs, who are only eating to survive. The pork barrel in politics is creating government waste in order to reward some special donor or interest group or to mollify a cranky member of Congress in return for his or her vote.

我們稱之為“豬肉桶”的方式，這是一個真正傷害到的豬，誰是只吃生存。在政治上的豬肉桶創造廢府為了獎勵一些特殊的捐贈者或利益集團或平息國會的胡思亂想成員以換取他或她的票。

And we’re paying for it.

我們正在為它付出。

I get very angry when I think about how our “Affordable Care” Act was rammed down a lot of sore throats by the Democrats.

我得到非常生氣，當我思考如何我們的“平價醫療”法案是由民主黨撞了很多喉嚨痛。

Even Nancy Pelosi, the Democratic House Majority Leader at the time, conceded that most supporters of the bill had not actually read it.

即使是南希·佩洛西，民主黨眾議院多數黨領袖的時候，承認該法案的支持者大部分實際上並沒有讀它。

Clearly, the public didn’t understand what “Obamacare” was providing: its complexity, its concessions to the insurance lobby, its taking away of the right to keep your current physicians, and, naturally, the hidden, escalating costs of health care, especially for state treasuries and businesses of all sizes. And for individuals who are young and healthy, there’s no way out of it without paying a fine.

顯然，公眾不明白什麼是“歐巴馬醫改”被提供：其複雜性，它的讓步保險大堂，其帶走的，以保持當前的醫生的權利，自然，健康護理的隱蔽性，成本上升，特別是對於各種規模的國庫和企業。而對於個人誰是年輕和健康，也沒有辦法了它無需支付罰款。

Virtually all Republicans—and a growing number of Democrats—realize this is already a disaster that will only get worse. Premiums are skyrocketing—up 30 percent to 50 percent—and that will only get worse.

幾乎所有共和黨人和越來越多的民主黨人意識到這已經是一個災難只會變得更糟。保費暴漲，高達30％至50％，而且只會變得更糟。

Look, I’m lucky. I’m able to afford the best health care in the world for myself and my family and my employees. I know that, but I also know that most people can’t do that and need some help. This is a subject that has been really important to me for a very long time.

你看，我很幸運。我能夠買得起世界上最好的醫療保健為我自己和我的家人和我的員工。我知道，但我也知道，大多數人無法做到這一點，需要一些幫助。這是一個一直對我真的很重要很長一段時間的主題。

There’s no question. Obamacare is a catastrophe, and it has to be repealed and replaced. And it was only approved because President Obama lied 28 times saying you could keep your doctor and your plan—a fraud and the Republicans should have sued—and meant it. As the different provisions kick in over the next few years, individual deductibles are going to continue to rise. People will have to get hit by a truck to be eligible for coverage because those deductibles are going to be so high.

毫無疑問。歐巴馬醫改是一場災難，它必須被廢除，取而代之。也就只有獲得批准，因為美國總統歐巴馬撒謊了28次說你可以保持您的醫生和你的計劃，欺詐和共和黨人應該起訴和真心話。由於不同的規定，在未來的幾年裡踢，個別免賠額會繼續上漲。人們將不得不不是被卡車撞才有資格進行覆蓋，因為這些免賠額將是如此之高。

Medical people hate it.

醫療人討厭它。

Doctors are quitting all over the place.

醫生們正在退出所有的地方。

I have a friend who is one of the best doctors in the country. You would know the names of many of his patients. He told me, “Donald, I’ve never seen anything like this. I can’t practice medicine the way I want to anymore. I have more accountants and computer programmers working for me than I have nurses.” He’s right. There are now more than 100 codes for doctors to get reimbursement from insurance companies.

我有一個朋友，誰是這個國家最好的醫生之一。你會知道他的許多病人的名字。他告訴我，“唐納德，我從來沒有見過這樣的事。我不能行醫我想再的方式。我有更多的會計和電腦程序員為我工作比我的護士。“他說的沒錯。現在有超過100碼的醫生從保險公司得到報銷。

We’ve turned the “paperwork” or “computer folders” in our medical system into the same nightmare as our 80,000-page tax code.

我們已將“文書工作”或“計算機文件夾”，在我們的醫療體制在同一個噩夢作為我們的80000頁的稅法。

As I’ve repeatedly said, the “un-Affordable” Care Act has to be replaced. Where I differ from what others say—as usual—is in the way I would change it. Many years ago, long before anybody else was talking about it, I knew we had to make changes in the system. I knew it because I saw what effect health care costs were having on the bottom line. I knew it because at that time we had more than 40 million Americans without any insurance at all, and now we are forcing “part-time” jobs down the system.

正如我多次所說，“非買得起”的醫療行為，必須更換。我來自哪裡有什麼不同，別人說的，像往常一樣，在我會改變它的方式。很多年前，長別人在談論它之前，我就知道我們不得不作出系統中的變化。我知道這是因為我看到了什麼樣的影響醫療費用的底線有。我知道這是因為在那個時候，我們有40多萬美國人沒有在所有任何保險，現在我們正在迫使“兼職”工作關閉系統。

I said then that we needed to find a plan for everyone that was affordable, well-administered, and that provided freedom of choice. You know, a plan that actually allows you to keep your doctor if you want to. At that time I talked about a single-payer plan which, in our then much less complicated system, may have had a chance of working. But it was only one of several suggestions from a nonpolitician at a time when many different concepts and ideas also were discussed. This was 15 years ago, but it still gets brought up a lot by other people. I guess they have nothing new to complain about. As usual, because they have no solutions of their own, they resort to “gotcha politics,” which gets us nowhere closer to solving this problem or any other. They are all talk and no action. The Affordable Care Act is a clear example of that.

然後我說，我們需要找到適合每一個人，這是經濟實惠，精心管理的計劃，所提供選擇的自由。要知道，一個計劃，實際上可以讓你保持你的醫生，如果你想。當時我談到了單一支付計劃，在我們則少得多複雜的系統，可能有工作的機會。但這只是從一次一nonpolitician若干建議之一，當許多不同的概念和想法進行了討論。這是15年前，但它仍然被其他人帶來了很多。我想他們有什麼新的抱怨。像往常一樣，因為他們沒有自己的解決方案，他們訴諸於“疑難雜症政治”，這會讓我們更接近無處解決這個問題或任何其他。他們都是光打雷不下雨。支付得起的醫療法就是一個明顯的例子。

To succeed in business, you have to be flexible and you have to change with the realities of the world. The world has changed; I’ve changed. I don’t think a single-payer system makes sense anymore. If I did, I would say it; I wouldn’t need anyone else to say it for me. Maybe a single-payer system works in other countries. It works incredibly well in Scotland, for example, and maybe it could have worked here at a different time.

要成功創業，你必須是靈活的，你與世界的現實改變。世界已經改變;我已經改變了。我不認為一個單一支付系統很有意義了。如果我這樣做，我會說這;我不需要任何人說這對我來說。也許一個單一支付系統的工作原理在其他國家。它的成效斐然，在蘇格蘭，例如，也許它可能在不同的時間在這裡工作。

But not anymore.

但現在不是了。

So what can we do about it? There’s no question we need real health care reform. We can’t let Americans go without health care because they don’t have the right resources. Sadly, that statement might cost me—but I still believe Republicans have big, beautiful “hearts” and want to help the poor and the sick—and can do so at the right price. I can’t even imagine what it must be like to be sick and unable to go to a doctor. This only throws people back into emergency rooms that are overcrowded and inefficient already.

所以，我們能做些什麼呢？毫無疑問，我們需要真正的醫療改革。我們不能讓美國人去無醫療保健，因為他們沒有合適的資源。可悲的是， 這種說法可能花了我，但我仍然相信，共和黨有大，美麗的“心”，想幫助窮人和病人，並能以適當的價格這樣做。我無法想像它必須像生病而無法去看病。這只會引發人們回到急診室，人滿為患，低效了。

The Census Bureau has reported that 10 million people have now been added to the system. We have to find a way to take care of those people who can’t take care of themselves. I believe that very strongly—even if it costs me.

人口普查局報告說，有10萬人現在已經被添加到系統中。我們必須找到一種方法，採取誰不能自理的人的照顧。我認為，非常強，即使它花了我。

I know Americans agree with me, because wherever I go in Ohio, Florida, Iowa, South Carolina, and New Hampshire, when I say it, people give me a standing ovation. The real argument is how do we take care of those who cannot take care of themselves? How do we make sure Americans have access to good health care so that our kids get everything they need, and that even people who can’t afford the basic programs get at least reasonable care?

我知道美國人同意我的看法，因為無論我走到哪裡在俄亥俄州，佛羅里達州，愛荷華州，南卡羅來納州和新罕布什爾州，當我說了吧，人家給我起立鼓掌。真正的理由是我們如何採取那些誰不能照顧自己的照顧？我們如何確保美國人都能獲得良好的保健，使我們的孩子得到他們所需要的一切，甚至人誰買不起基本的程序得到至少合理的照顧？

To me, for politicians to claim that we have an answer to every problem is silly. When you listen to some politicians reeling off their prepared answers, you almost fall for it. They’re so smart that they already have a solution to every problem, and it’s always better than everyone else’s solutions. How convenient. But not for our country, because nothing gets done. Nothing gets solved, and we don’t win. What I hear is a lot of ridiculous promises from politicians about how they intend to fix everything. They’re all experts. But nothing ever happens. They’re all talk and no action.

對我來說，權利要求政治家，我們必須回答每一個問題是愚蠢的。當你聽一些政客繅絲自己準備的答案，你幾乎愛上它。他們非常聰明，他們已經有一個解決每一個問題，它總是比其他人的解決方案更好。如何方便。但不適合我們的國家，因為什麼都做。沒有得到解決，我們不贏。我聽到很多可笑的承諾的政治家對他們打算如何解決一切。他們都是專家。但什麼都沒發生。他們都是光打雷不下雨。

Most of them have gotten really good at saying absolutely nothing. They’ve all got some kind of program, but when you listen to them, you still don’t know what they’re talking about.

他們中的大多數已經得到了在說絕對真的好沒有。他們都得到了一些種類的程序，但是當你聽他們的，你還是不知道他們在說什麼。

My approach is completely different. I approach complicated problems such as how to provide health care for most Americans at a price we can afford the same way I solve the toughest business problems. We should hire the most knowledgeable people in the world on this subject and lock them in a room—and not unlock the door until they’ve agreed on the steps we need to take.

我的做法是完全不同的。我的做法複雜的問題，例如如何在價格，我們可以承受同樣的方式我解決最棘手的業務問題提供了大多數美國人的衛生保健。我們應該聘請世界上最有知識的人對這個問題，並在鎖定他們的房間和，直到他們已經在我們需要採取的步驟同意不開門。

A lot of times when I speak, people say I don’t provide specific policies that some pollster has determined are what people want to hear. I know that’s not the way the professional politicians do it—they seem to poll and focus-group every word. But there’s nobody like me.

很多時候，當我說，人說我不提供，有些民調機構已經確定是人們想要聽到的具體政策。我知道這不是一路職業政客做，他們似乎輪詢和焦點小組的每一個字。但是，還有像我這樣的人。

Nobody.

沒有人。

I ask people to look at what I’ve done throughout my whole career. Look at how successful I’ve been doing things my way. So they have a choice: They can pretend some impossible solution is actually going to happen, or they can listen to the person who has proved that he can solve problems.

我請人看一下，我在我的整個職業生涯做。看看我有多成功一直在做我的方式行事。因此，他們有一個選擇：他們可以假裝一些不可能的解決方案實際上是將要發生，或者他們可以聽誰已經證明了他能解決問題的人。

I started in a relatively small real estate company based in Brooklyn and made more than $10 billion. I now live on what is considered the best block of real estate anywhere in the world—Fifth Avenue between 56th Street and 57th Street, right next to Tiffany’s in the heart of New York City.

我開始在總部設在布魯克林區一個相對較小的房地產公司並取得超過10十億$。我現在住在什麼被認為是在第56街和57街之間的世界第五大道的任何地方房地產的最佳攔網，緊鄰Tiffany的在紐約市的心臟地帶。

That doesn’t mean I don’t have some ideas about the right approach to take. First of all, we cannot cut either Social Security or Medicare benefits. That’s off the table. Those programs can be saved by growing the economy. Second, there are some simple changes that would provide real benefits.

這並不意味著我沒有要採取正確的方法的一些想法。首先，我們不能既削減社會保障和醫療保險福利。這是假表。這些程序可以通過發展經濟來保存。第二，有一些可以提供真正的實惠簡單的更改。

As I’ve said, I’d like to see a private insurance system without artificial lines drawn between states. We need to get rid of those lines and let people and companies cross state lines to purchase the best plan for them. The government should get out of the way and let insurance companies compete for your business.

正如我已經說過，我希望看到的私人保險體系沒有國家之間人工繪製線條。我們需要擺脫那些線條，讓人們和公司跨州界購買的最佳方案為他們。政府應該走出的方式，讓保險公司為您的企業競爭。

I have a big company. I have thousands of employees. If I’m negotiating for health insurance for my people in New York or California or Texas, I usually have one bidder in each state. Competition brings down prices, and the way the law is now, it discourages real competition between insurance companies for customers. They have virtual monopolies within the states. That makes no sense. It’s very stupid and unfair for us.

我有一個大的公司。我有成千上萬的員工。如果我談判為我的人民在紐約或加州或德州醫療保險，我通常在每個州一個投標人。競爭帶來的價格下降，而法律是現在的方式，鼓勵客戶保險公司之間真正的競爭。他們有國家內部的虛擬壟斷。這是沒有意義的。這是非常愚蠢的，對我們不公平的。

You know who loves a lack of competition? Those insurance companies, who are making a fortune because they control the politicians. They’ve paid for them with their contributions, and it’s a good investment from their perspectives. For our country, not so much. They give money to almost all the politicians. I’m using my own money so I am free to do what’s right, and serve the people, not the lobbyists.

你知道誰愛缺乏競爭？這些保險公司，誰是發大財，因為他們控制著政客。他們已經支付了他們與他們的貢獻，這是從他們的觀點一個很好的投資。對於我們的國家，沒有這麼多。他們把錢給幾乎所有的政治家。我用我自己的錢，所以我可以自由地做正確的事情，並服務於人民，而不是說客。

Nobody understands business better than I do. You want better plans at a better price? Increase competition for customers.

沒有人理解業務比我好。你想在一個更好的價格更好的計劃？提高客戶的競爭。

The government doesn’t belong in health care except as the very last resort. The main way the government should be involved is to make sure the insurance companies are financially strong so that if there is a catastrophic event or they make some kind of miscalculation, they have the resources they’ll need to handle it.

政府沒有在醫療保健屬於除非萬不得已的手段。政府應該參與的主要方式是，以確保保險公司有足夠的經濟強勁，因此，如果有災難性事件，否則做出某種誤判，他們有資源，他們需要處理它。

If we follow my logic, our health care system, and our economy, will be well again very soon.

如果我們按照我的邏輯，我們的醫療制度，我們的經濟將很快再次不失為。