美国国家公共电台 NPR Cat Bites The Hand That Feeds; Hospital Bills $48,512

 

DAVID GREENE, HOST:

Here's one reality in our health care system - prices that can be unpredictable and really, really high. Now, patients are told to be consumers, to shop around and find the best prices. But in some situations, you really can't do that. You are stuck at a hospital, which can charge you really whatever they want to. This is at the heart of our latest Bill of the Month segment Dr. Elisabeth Rosenthal from our partner Kaiser Health News is here to help us try and understand and dissect¹ a huge bill that was sent to us from a listener in the Florida Keys. Dr. Rosenthal, welcome back.

ELISABETH ROSENTHAL: Thanks for having me again.

GREENE: Well, who are we talking about today?

ROSENTHAL: We're talking about a bill from Jeannette Parker. She's 44, a biologist. And she was exposed to rabies or was afraid she might've been. So, as you can imagine, she was rather alarmed.

GREENE: Yeah. I mean, that can be fatal if you don't take care of it, right?

ROSENTHAL: Absolutely. Luckily, there are really effective treatments. But it involves getting some immune globulins and then, basically, a rabies vaccine², which is exactly what Jeannette did.

GREENE: OK. Well, let's hear her story. And then I want to come back to you and ask you some questions. But her story comes to us from reporter Nancy Klingener from our member station WLRN in South Florida. She went to visit Jeannette.

NANCY KLINGENER, BYLINE³: Jeannette Parker is an animal lover. That's obvious from the menagerie at her home in the Florida Keys.

JEANNETTE PARKER: Two dogs, three cats, sulcata tortoise - he's 80 pounds - poultry⁴, fish tanks, bearded dragon (laughter).

KLINGENER: That last one's a lizard⁵. Her cats are normally pretty shy around company, but one of them comes out to greet us while another streaks⁶ under the couch.

(SOUNDBITE OF CAT MEOWING)

PARKER: That is Breakneck Sally because she'll walk between your feet and trip you. So...

KLINGENER: Parker's love for animals has become part of her career. She's a wildlife biologist for the state of Florida, so she monitors the populations of endangered species like the Key deer and the lower Keys marsh⁷ rabbit. But her love for animals got her in trouble last September. She was on the mainland near Everglades National Park, and she saw a kitten by the side of the road.

PARKER: It's pretty common for people to dump animals in that area right outside the park.

KLINGENER: The kitten was skinny and looked like it was sick. Parker had a packet of tuna in the car and pulled over to give it some food.

PARKER: And in the process, he just grabbed onto my finger while he was eating. So he broke the skin on my finger.

KLINGENER: Parker says the kitten wasn't trying to bite her.

PARKER: And it was just a tiny, little scratch. And I was embarrassed to go to the emergency room over my tiny scratch. But he did break the skin, and I was bleeding. And there had been a rabies alert in the county that month. A couple of cats and quite a few raccoons tested positive and one otter⁸ also.

KLINGENER: So Parker went to the emergency room at Mariners⁹ Hospital just up the Overseas Highway from her house. She got the immunoglobulin injection that protects against rabies until the rabies vaccination¹⁰ takes effect.

PARKER: Yeah, I went home - just no big deal. I was in and out of there really fast.

KLINGENER: And then the bill came. The total cost was $48,000.

PARKER: And I thought it was a joke. I just couldn't believe it. It had to be a mistake. That was what I was thinking. I sort of laughed, and I was upset at the same time. Yeah, I couldn't believe it. For a shot, it was $48,000.

KLINGENER: Parker says she eventually stopped by the hospital to get an itemized bill, but they didn't drop the price. She had to pay $344 to cover her deductible, then 10 percent of the bill. Parker says no one at the ER said anything about cost when she was there. If she had realized how much it would be, she would've waited until Monday and gone to the county health department. The experience has given her a new perspective on money.

PARKER: I like to gauge¹¹ everything now by how much my rabies shot cost. So my boss got a new roof on his house, and it cost $20,000. And I was joking that you couldn't even get half a rabies vaccination for that.

KLINGENER: One thing has not changed because of this experience. She's still an animal lover.

Would you hesitate now before pulling over if you saw a sick animal on the side of the road?

PARKER: (Laughter) Probably not.

KLINGENER: And now with the protection of her rabies vaccine, she says she might be even more inclined to stop the next time.

GREENE: That story comes to us from Nancy Klingener from member station WLRN. She was reporting from Plantation¹² Key in Florida. I'm still with Dr. Elisabeth Rosenthal from Kaiser Health News. Dr. Rosenthal, $48,000 for a shot. And I'm just trying to do the math here. Jeannette had to pay 10 percent. I mean, she was responsible for more than $4,000.

ROSENTHAL: That's right. And, you know, rabies immunoglobulin is expensive, but many hospitals would charge about $3,000 for that. So the pricing here is pretty out of line.

GREENE: Well, why is the hospital able to charge, I mean, like, more than 10 times what it should be or what other hospitals charge?

ROSENTHAL: Well, you know, hospital prices are pretty arbitrary. There's little rhyme or reason for how they set their prices. And, hey, look, this is a medical service you can't refuse. You might've been exposed to rabies. So you're kind of a sitting duck, and they can basically charge whatever they want. The funny thing is when we looked into this, we discovered that the price of the rabies medicine Jeannette got dropped from about $7,000 a unit to about $1,650 a unit just a month or two later. So that shows you how crazy it is.

GREENE: Oh, so this hospital started charging dramatically less for this shot shortly after Jeanette was treated.

ROSENTHAL: Yes. And when we asked the hospital, they said, oh, well, we periodically adjust our prices. But I'd like to note that on January 1 this year, hospitals had to suddenly reveal their prices according to a new federal regulation. So they knew that that maybe-too-high $7,000 price would be out in the public as of January 1. So maybe they were trying to make adjustments before a new year came.

GREENE: Oh, wow. So the hospitals were trying not to look outrageous¹³ when they were actually required...

(LAUGHTER)

GREENE: ...To start telling people what they were charging.

ROSENTHAL: Well, that's one theory. You know, so the price dropped about 60 percent. And can you imagine if, like, you went to buy a Prius one month and it was $30,000, and the next month, on the first of the month, it was suddenly $10,000? I mean, that would be outrageous. But that's what happens in medical care all the time.

GREENE: I certainly couldn't imagine if I paid the $30,000 (laughter), and then saw it drop, like, the next day. What can you do, I mean, if you're bitten by an animal, and you go to the hospital, and you're desperate, and you don't know that they're charging this much?

ROSENTHAL: Since, for the moment, there's no kind of price-drop guarantee in health care, I think what you need to do, first of all, is protect your health. So you do need to go to the hospital. You need a rabies immunoglobulin. You should know that many public health departments will hand it out. So if it's during the week, you can check there first. And then, you know, try and go to an in-network hospital so at least you have better negotiating power.

GREENE: Is anything going to change for Jeanette? Can she get some money back?

ROSENTHAL: The problem with - in health care is that once you've spent, it's very hard to get money back. But her insurer is negotiating this. And I do hope that, you know, they look at this price drop and say, hey, what gives; we - she shouldn't be responsible for that big of a bill.

GREENE: Well, we'll hope for the best for her. Dr. Elisabeth Rosenthal, thanks as always.

ROSENTHAL: Thank you.

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1 dissect   

v.分割；解剖

参考例句：

• In biology class we had to dissect a frog.上生物课时我们得解剖青蛙。
• Not everyone can dissect and digest the public information they receive.不是每个人都可以解析和消化他们得到的公共信息的。

2 vaccine   

n.牛痘苗，疫苗；adj.牛痘的，疫苗的

参考例句：

• The polio vaccine has saved millions of lives.脊髓灰质炎疫苗挽救了数以百万计的生命。
• She takes a vaccine against influenza every fall.她每年秋季接种流感疫苗。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 poultry   

n.家禽，禽肉

参考例句：

• There is not much poultry in the shops. 商店里禽肉不太多。
• What do you feed the poultry on? 你们用什么饲料喂养家禽?

5 lizard   

n.蜥蜴，壁虎

参考例句：

• A chameleon is a kind of lizard.变色龙是一种蜥蜴。
• The lizard darted out its tongue at the insect.蜥蜴伸出舌头去吃小昆虫。

6 streaks   

n.（与周围有所不同的）条纹( streak的名词复数 )；（通常指不好的）特征（倾向）；（不断经历成功或失败的）一段时期v.快速移动( streak的第三人称单数 )；使布满条纹

参考例句：

• streaks of grey in her hair 她头上的绺绺白发
• Bacon has streaks of fat and streaks of lean. 咸肉中有几层肥的和几层瘦的。 来自《现代英汉综合大词典》

7 marsh   

n.沼泽，湿地

参考例句：

• There are a lot of frogs in the marsh.沼泽里有许多青蛙。
• I made my way slowly out of the marsh.我缓慢地走出这片沼泽地。

8 otter   

n.水獭

参考例句：

• The economists say the competition otter to the brink of extinction.经济学家们说，竞争把海獭推到了灭绝的边缘。
• She collared my black wool coat with otter pelts.她把我的黑呢上衣镶上了水獭领。

9 mariners   

海员，水手（mariner的复数形式）

参考例句：

• Mariners were also able to fix their latitude by using an instrument called astrolabe. 海员们还可使用星盘这种仪器确定纬度。
• The ancient mariners traversed the sea. 古代的海员漂洋过海。

10 vaccination   

n.接种疫苗，种痘

参考例句：

• Vaccination is a preventive against smallpox.种痘是预防天花的方法。
• Doctors suggest getting a tetanus vaccination every ten years.医生建议每十年注射一次破伤风疫苗。

11 gauge   

v.精确计量；估计；n.标准度量；计量器

参考例句：

• Can you gauge what her reaction is likely to be?你能揣测她的反应可能是什么吗？
• It's difficult to gauge one's character.要判断一个人的品格是很困难的。

12 plantation   

n.种植园，大农场

参考例句：

• His father-in-law is a plantation manager.他岳父是个种植园经营者。
• The plantation owner has possessed himself of a vast piece of land.这个种植园主把大片土地占为己有。

13 outrageous   

adj.无理的，令人不能容忍的

参考例句：

• Her outrageous behaviour at the party offended everyone.她在聚会上的无礼行为触怒了每一个人。
• Charges for local telephone calls are particularly outrageous.本地电话资费贵得出奇。