I finally got around to finishing “Bitter Pill: Why Medical Bills Are Killing Us,” the 24,000-word special report about healthcare costs that took up the entire feature section of the Feb. 20 edition of Time magazine. I was expecting to agree with most if not all of Steven Brill’s supposedly epic investigative piece. Instead, I was underwhelmed and quite disappointed that Brill, the founder of CourtTV (R.I.P., reincarnated as TruTV in Turner Broadcasting’s quest for more “reality” programming) and of American Lawyer magazine, only told half the story about all that ails the U.S. healthcare industry. Brill also editorializes far more than he should.
Granted, the story is about the high cost of care, but you can’t discuss cutting costs without also delving into the subject of improving outcomes. As has been stated in many other places, we have more of a sick-care system than a healthcare system. The incentives favor treating illness, not preventing it.
I have to say I learned a lot about how the racket known as the chargemaster works to keep the true costs of care opaque to patients. I suspect that, with the exception of uninsured people who are the only ones expected to pay full price, the public was unaware of the chargemaster system that hospitals guard like a state secret. Brill is right when he says, “Unless you have Medicare, the health care market is not a market at all. It’s a crapshoot.” But he’s not telling the full story. Medicare’s payment list is public, sure, but do Medicare beneficiaries really care what the federal government pays their hospitals and doctors? No, they, like everyone else with insurance coverage, only pay attention to their out-of-pocket cost.
Sure, Brill spends a lot of time discussing the perverse incentives in healthcare, particularly those that encourage expensive testing, and even touches on some of the reforms in the Patient Protection and Affordable Care Act that seem to have been left out of the debate over insurance coverage. Think the Medicare policy of not reimbursing hospitals for certain preventable readmissions.
But he completely neglects accountable care. Nor is there a mention of electronic health records and how interoperability can help reduce duplicate testing and unnecessary care. And he never addresses the elephant in the room, the shamefully high rate of medical errors that makes American healthcare far from the best in the world.