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Jeanne Pinder: What if all US health care costs were transparent?
Jeanne Pinder: Que pasaría se os custos sanitarios nos EUA fosen transparentes?
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Nos EUA a mesma análise de sangue pode custar 19 dólares nunha clínica e 522 noutra clínica próxima, e ninguén sabe desta diferenza até que semanas máis tarde recibe a factura. A xornalista Jeanne Pinder di que isto non debería ser así. Construíu unha plataforma que compara os verdadeiros custos dos procedementos médicos e fai pública esta información, amosando os segredos dos prezos dos servizos sanitarios. Saber canto custan con antelación as cousas pode facernos estar máis sans, aforrar diñeiro e, á vez, axudar a reconstruír un sistema roto.
Jeanne Pinder - Journalist
Jeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it. Full bio
Jeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it. Full bio
Double-click the English transcript below to play the video.
00:12
So, a little while ago,
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Hai algún tempo,
00:14
members of my family
had three bits of minor surgery,
had three bits of minor surgery,
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familiares meus necesitaron
tres pequenas cirurxías
tres pequenas cirurxías
00:17
about a half hour each,
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de preto de media hora cada unha.
00:19
and we got three sets of bills.
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E recibimos tres facturas.
00:22
For the first one, the anesthesia bill
alone was 2,000 dollars;
alone was 2,000 dollars;
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Na primeira, só a anestesia
xa eran 2000 dólares;
xa eran 2000 dólares;
00:26
the second one, 2,000 dollars;
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na segunda outros 2000 dólares;
00:28
the third one, 6,000 dollars.
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pero na terceira foron 6000 dólares.
00:32
So I'm a journalist.
I'm like, what's up with that?
I'm like, what's up with that?
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Son xornalista e pensei,
como é posible?
como é posible?
00:37
I found out that I was actually,
for the expensive one,
for the expensive one,
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Descubrín que na máis cara
00:40
being charged 1,419 dollars
for a generic anti-nausea drug
for a generic anti-nausea drug
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cobraran 1419 dólares
por un xenérico antináuseas
por un xenérico antináuseas
00:45
that I could buy online
for two dollars and forty-nine cents.
for two dollars and forty-nine cents.
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que eu mesma podía comprar
por 2,49 dólares.
por 2,49 dólares.
00:50
I had a long and unsatisfactory
argument with the hospital,
argument with the hospital,
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Tiven unha discusión longa
e insatisfactoria co hospital,
e insatisfactoria co hospital,
00:53
the insurer and my employer.
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o seguro e o meu xefe.
00:56
Everybody agreed
that this was totally fine.
that this was totally fine.
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Todos estaban de acordo coa factura.
00:59
But it got me thinking, and the more
I talked to people, the more I realized:
I talked to people, the more I realized:
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Canto máis falaba coa xente,
máis conta me daba dunha cousa:
máis conta me daba dunha cousa:
01:03
nobody has any idea
what stuff costs in health care.
what stuff costs in health care.
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ninguén sabe de verdade o prezo
que ten a sanidade.
que ten a sanidade.
01:06
Not before, during or after
that procedure or test
that procedure or test
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Nin antes, nin durante, nin despois
de calquera proceso médico
de calquera proceso médico
01:09
do you have any idea
what it's going to cost.
what it's going to cost.
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sabemos cal vai ser o seu custo.
01:11
It's only months later that you get
an "explanation of benefits"
an "explanation of benefits"
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Só uns meses despois recibes
a "explicación de prestacións"
a "explicación de prestacións"
que non dá demasiadas explicacións.
01:15
that explains exactly nothing.
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Este pensamento volveu a min
un pouco despois.
un pouco despois.
01:17
So this came back to me
a little while later.
a little while later.
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01:20
I had volunteered for a buyout
from the New York Times,
from the New York Times,
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Ofrecinme para unha saída voluntaria
do New York Times
do New York Times
01:23
where I had worked for more than
20 years as a journalist.
20 years as a journalist.
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no que traballara como xornalista
máis de 20 anos.
máis de 20 anos.
Estaba xa pensando no meu seguinte paso.
01:26
I was looking for my next act.
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01:28
It turned out that next act
was to build a company
was to build a company
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E este novo paso foi crear unha empresa
01:31
telling people what stuff costs
in health care.
in health care.
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que dixera cal é o custo
dos coidados sanitarios.
dos coidados sanitarios.
01:34
I won a "Shark Tank"-type
pitch contest to do just that.
pitch contest to do just that.
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E gañei un concurso, tipo Shark Tank,
para facer xusto iso.
para facer xusto iso.
Os custos da sanidade eran case o 18%
do PIB o ano pasado
do PIB o ano pasado
01:37
Health costs ate up almost 18 percent
of our gross domestic product last year,
of our gross domestic product last year,
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01:42
but nobody has any idea what stuff costs.
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pero ninguén sabe canto
custan as cousas.
custan as cousas.
Pero, e se o soubésemos?
01:45
But what if we did know?
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01:48
So we started out small.
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E comezamos por un pequeno proxecto.
01:49
We called doctors and hospitals
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Chamamos a médicos e a hospitais
01:51
and asked them what they would accept
as a cash payment for simple procedures.
as a cash payment for simple procedures.
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e preguntamos se en procedementos
simples aceptarían pago en efectivo.
01:57
Some people were helpful.
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Algunhas persoas quixeron axudar.
01:58
A lot of people hung up on us.
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Outras colgaban.
02:00
Some people were just plain rude.
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E algunhas outras enfadáronse.
02:02
They said, "We don't know,"
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Dicían: "Non sabemos"
02:04
or, "Our lawyers won't
let us tell you that,"
let us tell you that,"
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ou "os nosos avogados non nos deixan
falar diso".
falar diso".
02:07
though we did get a lot of information.
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E inda así conseguimos moita información.
02:10
We found, for example,
that here in the New York area,
that here in the New York area,
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Descubrimos, por exemplo,
que aquí en Nova York
que aquí en Nova York
02:12
you could get an echocardiogram
for 200 dollars in Brooklyn
for 200 dollars in Brooklyn
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podes facer un ecocardiograma
por preto de 200 $ en Brooklyn
por preto de 200 $ en Brooklyn
ou por 2150 $ en Manhattan,
estando a moi poucos quilómetros.
estando a moi poucos quilómetros.
02:17
or for 2,150 dollars in Manhattan,
just a few miles away.
just a few miles away.
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02:22
New Orleans, the same simple blood test,
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En Nova Orleáns a mesma
análise de sangue sinxela
análise de sangue sinxela
02:25
19 dollars over here,
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19 $ nun lugar e 522 $
noutro moi preto.
noutro moi preto.
02:27
522 dollars just a few blocks away.
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02:31
San Francisco, the same MRI,
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En San Francisco, 475 $
por unha resonancia magnética
por unha resonancia magnética
02:34
475 dollars
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02:36
or 6,221 dollars just 25 miles away.
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ou 6221 $ noutro lugar a só 40 km.
02:42
These pricing variations existed
for all the procedures
for all the procedures
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Estas diferenzas de prezo existen
en todos os procedementos
en todos os procedementos
e en todas as cidades que enquisamos.
02:46
and all the cities that we surveyed.
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Entón empezamos a preguntarlle á xente
polas súas facturas médicas.
polas súas facturas médicas.
02:49
Then we started to ask people
to tell us their health bills.
to tell us their health bills.
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02:52
In partnership with public radio station
WNYC here in New York,
WNYC here in New York,
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En colaboración coa radio pública
de aquí, de Nova York,
de aquí, de Nova York,
02:56
we asked women to tell us
the prices of their mammograms.
the prices of their mammograms.
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pedímoslles ás mulleres que nos deran
os prezos das súas mamografías.
os prezos das súas mamografías.
02:59
People told us nobody would do that,
that it was too personal.
that it was too personal.
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Dicíannos que ningunha o faría,
que era demasiado persoal.
que era demasiado persoal.
Pero en tres semanas,
03:03
But in the space of three weeks,
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400 mulleres falaran con nós
dos seus prezos.
dos seus prezos.
03:05
400 women told us about their prices.
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Nese momento, comezamos a promover
03:09
Then we started to make it easier
for people to share their data
for people to share their data
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que a xente compartise os seus datos
na nosa plataforma en Internet.
na nosa plataforma en Internet.
03:12
into our online searchable database.
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É unha mestura entre kayak.com e
a aplicación Waze pero para a saúde.
a aplicación Waze pero para a saúde.
03:15
It's sort of like a mash-up of Kayak.com
and the Waze traffic app for health care.
and the Waze traffic app for health care.
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03:20
(Laughter)
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(Risas)
03:21
We call it a community-created
guide to health costs.
guide to health costs.
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Chamámoslle guía comunitaria
dos custos da saúde.
dos custos da saúde.
03:24
Our survey and crowdsourcing work
grew into partnerships
grew into partnerships
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O noso traballo de enquisa
e colaboración aberta
e colaboración aberta
medrou ao asociarnos
con redaccións de todo o país:
con redaccións de todo o país:
03:26
with top newsrooms nationwide --
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03:28
in New Orleans, Philadelphia,
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Nova Orleáns, Filadelfia,
03:30
San Francisco, Los Angeles,
Miami and other places.
Miami and other places.
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San Francisco, Os Ánxeles,
ou Miami, entre outros.
ou Miami, entre outros.
03:35
We used the data to tell stories
about people who were suffering
about people who were suffering
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Usamos os datos para contar as historias
das persoas que sofren,
das persoas que sofren,
03:39
and how to avoid that suffering,
to avoid that "gotcha" bill.
to avoid that "gotcha" bill.
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como evitar isto e tamén evitar
estas facturas.
estas facturas.
03:44
A woman in New Orleans saved
nearly 4,000 dollars using our data.
nearly 4,000 dollars using our data.
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Unha muller en Nova Orleáns aforrou
uns 4000 $ grazas aos nosos datos.
uns 4000 $ grazas aos nosos datos.
03:49
A San Francisco contributor
saved nearly 1,300 dollars
saved nearly 1,300 dollars
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Un colaborador de San Francisco,
case 1300 $
case 1300 $
03:52
by putting away his insurance card
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renunciando á súa póliza de seguros
03:54
and paying cash.
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e facendo o pago en metálico.
03:56
There are a lot of people
who are going to in-network hospitals
who are going to in-network hospitals
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Hai moitas persoas que van
á súa rede de hospitais
á súa rede de hospitais
pero que reciben facturas de fóra dela.
03:59
and getting out-of-network bills.
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04:01
And then there was the hospital
that continued to bill a dead man.
that continued to bill a dead man.
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E mesmo había un hospital que facturaba
a un home xa finado.
a un home xa finado.
04:05
We learned that thousands of people
wanted to tell us their prices.
wanted to tell us their prices.
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Soubemos que milleiros de persoas
nos querían dicir os seus prezos.
nos querían dicir os seus prezos.
04:08
They want to learn what stuff costs,
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Querían saber o que custan as cousas,
04:10
find out how to argue a bill,
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saber como discutir unha factura,
04:11
help us solve this problem that's hurting
them and their friends and families.
them and their friends and families.
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axudar a solucionar un problema
que lles afecta a eles,
que lles afecta a eles,
aos seus amigos e familias.
Falabamos con persoas que tiveran que
vender o coche
vender o coche
04:15
We talked to people who had
to sell a car to pay a health bill,
to sell a car to pay a health bill,
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para pagar as facturas,
que entraran en quebra,
que entraran en quebra,
04:18
go into bankruptcy,
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04:20
skip a treatment because of the cost.
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ou que deixaran o tratamento
polo alto prezo.
polo alto prezo.
Imaxinen que poidan pagar o diagnóstico
04:23
Imagine if you could afford the diagnosis
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pero non a cura.
04:25
but not the cure.
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Comezamos unha enorme conversa
sobre os custos
sobre os custos
04:29
We set off a huge conversation about costs
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04:31
involving doctors and hospitals, yes,
but also their patients,
but also their patients,
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con médicos e hospitais, si,
pero tamén cos doentes.
pero tamén cos doentes.
04:35
or as we like to call them, people.
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Ou como nos gusta chamalos, xente.
04:37
(Laughter)
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(Risas)
Cambiamos a política.
04:41
We changed policy.
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04:42
A consumer protection bill
that had been stalled
that had been stalled
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Un proxecto de lei de protección
ao consumidor,
ao consumidor,
parado 10 anos no lexislativo de Luisiana
04:45
in the Louisiana legislature for 10 years
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04:47
passed after we launched.
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foi aprobado tras o noso lanzamento.
Sexamos sinceros,
04:50
Let's face it:
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04:51
this huge, slow-rolling
public health crisis
public health crisis
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esta gran e lenta crise
da sanidade pública
da sanidade pública
é unha emerxencia nacional.
04:54
is a national emergency.
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E non creo que o goberno
nos vaia axudarnos no curto prazo.
nos vaia axudarnos no curto prazo.
04:56
And I don't think government's
going to help us out anytime soon.
going to help us out anytime soon.
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05:00
But what if the answer was really simple:
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Mais, e se a resposta fose sinxela
05:02
make all the prices public all the time.
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como facer que todos os prezos
fosen públicos?
fosen públicos?
05:06
Would our individual bills go down?
Our health premiums?
Our health premiums?
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Baixarían as facturas? As primas?
Teñan isto claro.
05:11
Be really clear about this:
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05:13
this is a United States problem.
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É un problema dos EUA.
En boa parte do mundo desenvolvido
05:15
In most of the rest
of the developed world,
of the developed world,
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05:17
sick people don't have
to worry about money.
to worry about money.
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as persoas non se teñen
que preocupar polo diñeiro.
que preocupar polo diñeiro.
05:20
It's also true that price transparency
will not solve every problem.
will not solve every problem.
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Tamén é certo que a transparencia
nos prezos non o resolve todo.
nos prezos non o resolve todo.
Aínda haberá tratamentos caros
05:24
There will still be expensive treatments,
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e unha gran fricción
no noso sistema de seguros.
no noso sistema de seguros.
05:27
huge friction from our insurance system.
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Haberá fraude aínda
05:29
There will still be fraud
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e un problema masivo
de sobretratamento e sobrediagnóstico.
de sobretratamento e sobrediagnóstico.
05:31
and a massive problem
with overtreatment and overdiagnosis.
with overtreatment and overdiagnosis.
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05:35
And not everything is shoppable.
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E non todo se compra con diñeiro.
Non todo o mundo quere a apendicectomía
05:38
Not everybody wants
the cheapest appendectomy
the cheapest appendectomy
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ou o tratamento para o cancro
máis baratos.
máis baratos.
05:40
or the cheapest cancer care.
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05:43
But when we talk
about these clear effects,
about these clear effects,
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Mais cando falamos destes efectos claros,
05:45
we're looking at a real issue
that's actually very simple.
that's actually very simple.
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vemos un problema que é
realmente moi sinxelo.
realmente moi sinxelo.
05:50
When we first started calling for prices,
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Cando comezabamos a chamar
para pedir prezos,
para pedir prezos,
05:52
we actually felt like
we were going to be arrested.
we were going to be arrested.
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sentíamos que nos ían arrestar.
05:55
It seemed kind of transgressive
to talk about medicine and health care
to talk about medicine and health care
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Parecía infrinxir algunha norma falar
de medicina e de asistencia sanitaria
de medicina e de asistencia sanitaria
na mesma frase,
05:58
in the same breath,
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mais resultou liberador.
06:00
and yet it became liberating,
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06:01
because we found not only data
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Non só atopamos datos
senón tamén boas persoas no sistema
06:04
but also good and honest people
out there in the system
out there in the system
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que queren axudar á xente
a ter os coidados que precisan
a ter os coidados que precisan
06:06
who want to help folks
get the care they need
get the care they need
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06:08
at a price they can afford.
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e a un prezo que poidan pagar.
06:11
And it got easier to ask.
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Fíxose máis fácil preguntar.
06:13
So I'll leave you with some questions.
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Así que acabo con algunhas cuestións.
06:15
What if we all knew what stuff cost
in health care in advance?
in health care in advance?
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E se soubésemos todos o que custan
os coidados médicos por adiantado?
os coidados médicos por adiantado?
06:19
What if, every time
you Googled for an MRI,
you Googled for an MRI,
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Que pasaría se cando buscase en Internet
"resonancia magnética"
"resonancia magnética"
06:23
you got drop-downs telling you
where to buy and for how much,
where to buy and for how much,
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se despregase un menú coa información
sobre onde comprala e os prezos,
sobre onde comprala e os prezos,
06:26
the way you do when
you Google for a laser printer?
you Google for a laser printer?
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igual que pasa cando buscas
unha impresora láser?
unha impresora láser?
06:30
What if all of the time and energy
and money that's spent hiding prices
and money that's spent hiding prices
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Que pasaría se todo o tempo, enerxía e
diñeiro que se gasta ocultando os prezos
diñeiro que se gasta ocultando os prezos
06:34
was squeezed out of the system?
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se eliminase do sistema?
06:37
What if each one of us could pick
the $19 test every time
the $19 test every time
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Que pasaría se cada un puidese
escoller a proba de 19 $
escoller a proba de 19 $
06:40
instead of the $522 one?
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en lugar da de 522 $?
06:43
Would our individual bills go down?
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Baixarían as nosas facturas?
06:45
Our premiums?
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As nosas primas do seguro?
06:46
I don't know, but if you don't ask,
you'll never know.
you'll never know.
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Non o sei, mais se non se pregunta
nunca o saberemos.
nunca o saberemos.
06:49
And you might save a ton of money.
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E cada un poderíamos aforrar
moitos cartos.
moitos cartos.
06:51
And I've got to think that a lot of us
and the system itself
and the system itself
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E teño que pensar que moitos de nós,
e o propio sistema, seriamos máis sans.
e o propio sistema, seriamos máis sans.
06:55
would be a lot healthier.
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06:57
Thank you.
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Grazas.
(Aplausos)
06:58
(Applause)
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ABOUT THE SPEAKER
Jeanne Pinder - JournalistJeanne Pinder asks why it's so hard to make sense of US healthcare bills -- and suggests what we might do about it.
Why you should listen
Lifelong journalist Jeanne Pinder is founder and CEO of ClearHealthCosts, a digital media startup that demands price transparency from the US healthcare system. After taking a buyout from the New York Times, where she worked for more than 20 years, she won a Shark Tank-style competition with her ClearHealthCosts pitch and hasn't looked back.
Since its founding in 2011, ClearHealthCosts has won a slew of journalism grants and prizes and has reported on and crowdsourced health price data in partnership with prestigious newsrooms in New Orleans, Philadelphia, Miami, San Francisco, Los Angeles, New York and elsewhere. This work has won numerous journalism prizes -- a national Edward R. Murrow award, a Society for Professional Journalists public service gold medal and a spot as a finalist for a Peabody Award, among others.
Pinder and the company have won grants from the John S. and James L. Knight Foundation, the International Women's Media Foundation, the Tow Center for Digital Journalism at Columbia University, the Tow-Knight Center for Entrepreneurial Journalism at the CUNY Graduate School of Journalism and others.
Previously, in her native Iowa, Pinder worked at The Des Moines Register and the Grinnell Herald-Register, a twice-weekly newspaper that her grandfather bought in 1944.
Pinder speaks fluent but rusty Russian. In a previous lifetime, she lived in what was then the Soviet Union, a place almost as mysterious as the US healthcare marketplace.
Jeanne Pinder | Speaker | TED.com