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Colfax Avenue, here in Denver, Colorado, was once called the longest, wickedest street in America.
科尔法克斯大道位于科罗拉多州丹佛市，曾被称为美国“最长，最邪恶的街道”。
My office is there in the same place -- it's a medical desert.
我的办公室就在那儿--那片医疗资源极度匮乏的地区。
There are government clinics and hospitals nearby, but they're not enough to handle the poor who live in the area.
虽然附近有政府诊所和医院，但根本不够医治这个地区的穷人。
By poor, I mean those who are on Medicaid.
我所说的穷人是指那些接受医疗补助的人。
Not just for the homeless; 20 percent of this country is on Medicaid.
不仅指无家可归的人；美国有20%的人都接受医疗补助。
If your neighbors have a family of four and make less than $33,000 a year, then they can get Medicaid.
如果你邻居家有四口人，年收入不到33000美元，那么他们就能获得医疗补助。
But they can't find a doctor to see them.
然而他们却找不到医生治病。
A study by Merritt Hawkins found that only 20 percent of the family doctors in Denver take any Medicaid patients.
梅里特霍金斯公司做的一个研究发现，丹佛只有20%的家庭医生接受使用医疗补助的病人。
And of those 20 percent, some have caps, like five Medicaid patients a month.
在这20%的医生中，有的有数量限制，比如一个月看5位医疗补助病人。
Others make Medicaid patients wait months to be seen, but will see you today, if you have Blue Cross.
有些医生则让使用医疗补助的病人等上几个月，但如果你有蓝十字医疗险，你今天就能接受治疗。
This form of classist discrimination is legal and is not just a problem in Denver.
这种阶级歧视是合法的，并且不仅丹佛存在这个问题。
Almost half the family doctors in the country refuse to see Medicaid patients.
几乎一半的美国家庭医生都拒绝接收使用医疗补助的病人。
Why? Well, because Medicaid pays less than private insurance and because Medicaid patients are seen as more challenging.
为什么？因为医疗补助支付的金额比私人保险低，而且人们总觉得接收使用医疗补助的病人更麻烦。
Some show up late for appointments, some don't speak English and some have trouble following instructions.
他们有些人会迟到，有些人不会说英语，有些人在遵循医嘱上也存在困难。
I thought about this while in medical school.
在医学院时我就想过这些问题。
If I could design a practice that caters to low-income folks instead of avoiding them,
如果我能设计出一个适合低收入人群而非拒绝他们的医疗模式，
then I would have guaranteed customers and very little competition.
那么我的客源就有保证，而且竞争很小。
So after residency, I opened up shop, doing underserved medicine.
所以在住院医生实习结束后，我开了一家服务低医疗服务水平人群的诊所。
Not as a nonprofit, but as a private practice.
不是非盈利组织，而是私人诊所。
A small business seeing only resettled refugees.
一个小生意，只为重新安置的难民看病。
That was six years ago, and since then, we've served 50,000 refugee medical visits.
那是在6年前，自那之后，我们已经为5万难民提供了医疗服务。
Ninety percent of our patients have Medicaid, and most of the rest, we see for free.
我们的病人中90%有医疗补助，对其他剩下的大部分人，我们提供免费诊疗。
Most doctors say you can't make money on Medicaid, but we're doing it just fine.
很多医生说你无法在使用医疗补助的病人身上赚钱，但我们的收入还不错。
How? Well, if this were real capitalism, then I wouldn't tell you, because you'd become my competition.
如何做到的呢？如果这是资本主义，我可不会告诉你，因为你们会成为我的竞争对手。
But I call this "bleeding-heart" capitalism.
但我把这称为“软心肠”的资本主义。
And we need more people doing this, not less, so here's how.
我们需要更多的人参与进来，我们是这么做的。
We break down the walls of our medical maze by taking the challenges of Medicaid patients,
我们把服务使用医疗补助的病人的挑战转化为机会，
turning them into opportunities, and pocketing the difference.
并从中赚取差价，来解开我们的医疗谜题。
The nuts and bolts may seem simple, but they add up.
螺母和螺栓看起来很简单，但它们加起来却能发挥巨大的作用。
For example, we have no appointments. We're walk-in only.
比如，我们无需预约。我们采取即到即诊的模式。
Of course, that's how it works at the emergency room, at urgent cares and at Taco Bell.
也就是说，急诊室和塔可钟（墨西哥快餐品牌）采用了相同的模式。
But not usually at family doctor's offices. Why do we do it?
但这些在家庭医生的办公室并不常见。我们为什么要这样做？
Because Nasra can't call for an appointment. She has a phone, but she doesn't have phone minutes.
因为像纳斯拉这样的人没法预约。她有电话，但她没钱付话费。
She can't speak English, and she can't navigate a phone tree.
她不会说英语，也不会查询通讯录。
And she can't show up on time for an appointment because she doesn't have a car,
她无法在预约时间准时出现，因为她没有私家车，
she takes the bus, and she takes care of three kids plus her disabled father.
她需要乘坐公车，并且她需要照顾3个小孩外加她残疾的父亲。
So we have no appointments; she shows up when she wants, but usually waits less than 15 minutes to be seen.
所以我们不提供预约服务；她想来的时候就来，通常等待不到15分钟就能就诊。
She then spends as much time with us as she needs.
我们会充分保证她的就诊时长。
Sometimes that's 40 minutes, usually it's less than five.
有时候是40分钟，但通常不到5分钟。
She loves this flexibility. It's how she saw doctors in Somalia.
她喜欢这种弹性。她在索马里就是这样看医生的。
And I love it, because I don't pay staff to do scheduling, and we have a zero no-show rate and a zero late-show rate.
这也让我很开心，因为我不需要额外雇人负责预约事项，我们的爽约率和迟到率为零。
It makes business sense.
这很有商业价值。
Another difference is our office layout.
另一个不同是我们办公室的布局。
Our exam rooms open right to the waiting room, our medical providers room their own patients,
我们的检查室和候诊室相通，每个医生都和他们自己的病人独享一个房间，
and our providers stay in one room instead of alternating between rooms.
我们的服务人员集中在一个房间里，而不需要在两个房间之间来回穿梭。
Cutting steps cuts costs and increases customer satisfaction.
削减流程降低了成本，提高了客户满意度。
We also hand out free medicines, right from our exam room: over-the-counter ones and some prescription ones, too.
我们还在诊室分发免费药品：非处方药和一些处方药。
If Nasra's baby is sick, we put a bottle of children's Tylenol or amoxicillin right in her hand.
如果纳斯拉的孩子病了，我们会直接给她一瓶儿童泰诺或阿莫西林。
She can take that baby straight back home instead of stopping at the pharmacy.
她可以直接带孩子回家，而无需再去药店。
I don't know about you, but I get sick just looking at all those choices. Nasra doesn't stand a chance in there.
我不知道你们怎么想，但我一见到这一大堆药就头晕。纳斯拉根本没法在这里买药。
We also text patients. We're open evenings and weekends.
我们也给病人发短信。我们晚上和周末都营业。
We do home visits. We've jumped dead car batteries.
我们做家访。我们把汽车电池都跑到没电了。
With customer satisfaction so high, we've never had to advertise, yet are growing at 25 percent a year.
有这么高的客户满意度，我们根本不用打广告，还能以每年25%的速度增长。
And we've become real good at working with Medicaid, since it's pretty much the only insurance company we deal with.
我们变得很熟悉Medicaid的业务，因为它几乎是我们唯一合作的保险公司。
Other doctor's offices chase 10 insurance companies just to make ends meet. That's just draining.
其他医生的诊所同时与10家保险公司合作以实现收支平衡，但收效甚微。
A single-payer system is like monogamy: it just works better.
单一支付方制度就像一夫一妻制: 它就是效果更好。
Of course, Medicaid is funded by tax payers like you,
当然，医疗补助计划由像你们这样的纳税人资助，
so you might be wondering, "How much does this cost the system?"
所以你们可能会好奇，“这个系统要花多少钱？”
Well, we're cheaper than the alternatives.
我们比主流方案便宜。
Some of our patients might go to the emergency room, which can cost thousands, just for a simple cold.
我们有些病人去急诊室，仅仅一个简单的感冒，就要花数千美元。
Some may stay home and let their problems get worse.
有些人则呆在家中，坐等问题恶化。
But most would try to make an appointment at a clinic that's part of the system called the Federally Qualified Health Centers.
但是大多数人会尝试在属于联邦授权医疗中心的一个诊所预约。
This is a nationwide network of safety-net clinics
这是一个覆盖全国的诊所安全网络，
that receive twice as much government funding per visit than private doctors like me.
每次看病得到的政府资助是像我这样的私人医生的两倍。
Not only they get more money, but by law, there can only be one in each area.
他们不仅收取更高的费用，根据法律，每个地区只能有一个。
That means they have a monopoly on special funding for the poor.
这意味着他们垄断了为穷人提供的特殊资金。
And like any monopoly, there's a tendency for cost to go up and quality to go down.
跟任何垄断一样，总是成本会上升，质量会下降。
I'm not a government entity; I'm not a nonprofit. I'm a private practice.
我不是政府实体，我不是非盈利组织。我是个私人诊所。
I have a capitalist drive to innovate. I have to be fast and friendly.
我有资本主义的创新动力。我必须高效和友好。
I have to be cost-effective and culturally sensitive. I have to be tall, dark and handsome.
我得有成本效益和文化敏感性。我必须又高又黑又帅。
And if I'm not, I'm going out of business.
如果不具备这些，我的生意就会垮掉。
I can innovate faster than a nonprofit, because I don't need a meeting to move a stapler.
我比非盈利组织在创新方面更高效，因为我不需要开个会来决定是否拆除缝合器。
Really, none of our innovations are new or unique
我们的创新都不是新的或独创的，
we just put them together in a unique way to help low-income folks while making money.
我们只是用一种独特的方法把它们组合在一起，在帮助低收入人群的同时还赚钱。
And then, instead of taking that money home, I put it back into the refugee community as a business expense.
然后，我会把这些钱投入难民社区作为商业支出，而不是拿回家。
This is Mango House. My version of a medical home.
这是芒果屋。我创建的医疗之家。
In it, we have programs to feed and clothe the poor, an after-school program,
在那里，我们为穷人提供食物和衣服，提供课外项目，
English classes, churches, dentist, legal help, mental health and the scout groups.
英语课，教堂，牙医，法律援助，心理辅导和童子军等项目。
These programs are run by tenant organizations and amazing staff,
这些项目由承租组织和出色的员工运作，
but all receive some amount of funding form profits from my clinic.
但他们都从我的诊所获得了一些资金。
Some call this social entrepreneurship. I call it social-service arbitrage.
有人称之为社会企业家精神。我称之为社会服务套利。
Exploiting inefficiencies in our health care system to serve the poor.
利用我们卫生保健系统的低效率为穷人服务。
We're serving 15,000 refugees a year at less cost than where else they would be going.
我们每年服务15000位难民，且比其他地方花费更少。
Of course, there's downsides to doing this as a private business, rather than as a nonprofit or a government entity.
当然，作为私人企业，既非非盈利组织，也非政府实体，做这个也有不利的一面。
There's taxes and legal exposures. There's changing Medicaid rates and specialists who don't take Medicaid.
有税收和法律风险。有不断变化的医疗补助率和不接受医疗补助病人的专家。
And there's bomb threats. Notice there's no apostrophes, it's like, "We were going to blow up all you refugees!"
还有炸弹威胁。请注意，这里少了个标点符号，所以表达的意思就变成了，“我们本来要炸掉你们这些难民！”
"We were going to blow up all you refugees, but then we went to your English class, instead."
“我们本来要炸掉你们这些难民，但后来我们去上了你们的英语课。”
Now, you might be thinking, "This guy's a bit different."
现在，你可能在想，“这家伙的确有一套。”
Uncommon. A communal narcissist?
罕见。一个公共自恋者？
A unicorn, maybe, because if this was so easy, then other doctors would be doing it.
也许还是独角兽，但如果这么简单的话，其他医生也会这样做。
Well, based on Medicaid rates, you can do this in most of the country.
根据医疗补助率，你可以在全国大部分地区这样做。
You can be your own boss, help the poor and make good money doing it.
你可以做自己的老板，帮助穷人并赚大钱。
Medical folks, you wrote on your school application essays that you wanted to help those less fortunate.
医学院的人可能在申请学校时说过你想帮助那些不幸的人。
But then you had your idealism beaten out of you in training.
但你的理想情怀在训练过程中丢掉了。
Your creativity bred out of you. It doesn't have to be that way.
你的创造力不复存在了。你们本可以做得更好。
You can choose underserved medicine as a lifestyle specialty.
你可以选择医疗服务不足的领域作为毕生专业。
Or you can be a specialist who cuts cost in order to see low-income folks.
或者你可以选择成为降低成本，为低收入人群看病的专家。
And for the rest of you, who don't work in health care, what did you write on your applications?
对不从事医疗保健行业的其他人来讲，你的申请表是怎么写的？
Most of us wanted to save the world, to make a difference.
我们大部分人想要拯救世界，改变现状。
Maybe you've been successful in your career but are now looking for that meaning? How can you get there?
你们也许在你们的职业中已足够成功，现在正在寻找生活的意义？你如何能够实现那个目标？
I don't just mean giving a few dollars or a few hours;
我指的不是捐献一些钱或几个小时；
I mean how can you use your expertise to innovate new ways of serving others. It might be easier than you think.
我的意思是你如何使用你的专业技能，以新的方式去服务他人？这可能没你想的那么难。
The only way we're going to bridge the underserved medicine gap is by seeing it as a business opportunity.
我们能够弥补医疗服务不足的唯一方法是将其视为商业机会。
The only way we're going to bridge the inequality gap is by recognizing our privileges and using them to help others.
我们缩小不平等差距的唯一途径是认识到我们的特权，并利用这些特权帮助他人。
