Letters to the Editor: Read Reactions to ‘Bitter Pill’

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As a surgeon, I want to commend Steven Brill on an outstanding article. A detailed discussion about the pricing and profits in health care is long overdue. You succeeded in putting a personal face on this crisis, and yes, it is a crisis. Most people are not aware of the outrageous costs  until they or a family member becomes ill. Indeed, we are but one major illness away from bankruptcy. To the Republicans: the health care market is not a free market. Competition raises costs, it does not lower them. Why? Fancy new buildings and technology of dubious benefit raise costs. Patients always demand what’s new, because it is perceived to be better, even when it is not.  Get over your dislike of President Obama; being against Obamacare is not enough. Our healthcare costs are bankrupting our nation and hurting our international competitiveness. You need to come up with realistic, constructive solutions. As on the issue of Social Security and Medicare, you risk being on the wrong side of history. To President Obama and the Democrats: Do not think that we practicing physicians love everything about Obamacare. The goal of universal coverage is laudable. But your failure to address the issue of cost, so eloquently illustrated in this article, will bring the entire health care system down very soon if it is not addressed. And I appreciate the article’s emphasis on the need for liability reform. The hidden cost is enormous.
Roger R Perry, MD, FACS
Virginia Beach, Va.

(COMPLETE COVERAGEWhy Medical Bills Are Killing Us)

I read Mr. Recchi’s story with interest on several levels. First, as a physician, I know how important it is for Americans that health care “get it right.” Second, as a person also diagnosed with non-Hodgkin’s Lymphoma, I understand the fear and uncertainty that comes with such a devastating diagnosis. And finally, on a third level, I serve as Chief Medical Officer for a company whose vision is to improve the quality and lower the cost of healthcare through better use of data and analytics.  I can understand the frustration of not being able to get answers to questions such “where can I get the best care”, “what should it cost” and “how can I compare hospitals to understand my options?” As a country, we are starting to turn the corner by exploring new payment models, facilitating price transparency and, most importantly, moving away from a payment system that financially incents doctors to do more, expects individuals to not care about the costs and rewards hospitals if they “keep the beds full,” all while not singularly focusing on improving the quality of the care provided. For many, U.S. health care is the best in the world. For many others, it is not obtainable. It is a travesty that Mr. Recchi will go bankrupt in getting the care he needs, while the next personmwith non-Hodgkin’s lymphoma may not even notice the price tag.
Michael Taylor MD, FACP,
Chief Medical Officer, Truven Health Analytics
Ann Arbor, MI

Excellent work by Steven Brill on health care costs.  It is good to see our government beating down the chargemaster.  Since hospitals do not have a problem delaying treatment until they see the money, then a slight delay to see the chargemaster-proposed billing in advance of treatment should be required.  Just like at the car repair shop – no advance quote, no pay required.
Gary DeShano, Gladwin, Mich.

What a great way for the Republican party to redeem themselves in the next election cycle- promote a smart, effective pro-health care competition bill embracing the things Steven Brill recommends in his article in a way that makes it as hard as possible to bypass and water down with riders to other bills. Signing on would be a wonderful litmus test for all elected officials that both the Tea Party, Coffee Party, and almost every other political movement out there can support. This would render the health care industry ineffective against lobbying successfully for business as usual.
Ned Wulin, Fishersville, Va.

Thank you for Mr. Brill’s important and compelling report.  Our own experience with M.D. Anderson ended a year ago, when our 26 year-old daughter died of complications from leukemia after two years under their care.  Although the doctors, nurses, and other professionals at MDA were caring, our experience with the hospital administration was much like the Recchi’s experience. Fortunately for us, our insurance nightmare ended, and our insurance carrier provided very good coverage.  It is not at all clear, however, if we had not had the financial means to make a large up-front payment and access to legal resources to compel our carrier to provide insurance coverage, that Sarah could have received treatment at MDA. We have made some significant contributions to MDA in the past year.  But now that we have a clearer picture of its finances, the ethics of allocating our charitable dollars to such an outrageously wealthy organization seems highly questionable.
Clare Doyle, Houston, Texas

I am amazed at your painstakingly amazing and honest article. We may still be the greatest superpower in the world but we are definitely heading toward our own destruction.
Chake Kouyoumjian, Associate Dean of Graduate Studies,
Loyola Marymount University,
Los Angeles

(COVER STORY: Bitter Pill)

Steve Brill’s article Bitter Pill is the most comprehensive and analytical treatment I have seen on the state of health care.  The failure of Obamacare to address medical malpractice and the official sanctioning of an incomprehensible and irrational method of billing and payment should outrage any American, but does not, because most are insured in some form or another and someone else is paying the bill. Although Mr. Brill suggests excellent solutions, the real root of the problem in health care lies in the unholy alliance of the special interests and their lobbyists and the elected officials of both parties and the regulators.  What congressman for example, with the interests of the country and taxpayers in mind, would vote for a law which bars the government from negotiating with drug manufacturers for a lower price?
Alfred A. Volkmann, Shoreham, NY

I almost had a heart attack reading Steven Brill’s “Bitter Pill”  — but realized I really couldn’t afford it!
Isaac M. Jaroslawicz, Bay Harbor Islands, Fla.

Kudos to Steven Brill and Time Magazine for this informative report! This is what journalism should be.
Gloria Cingano, Imperial, Mo.

Thanks for lifting up the rug and shining much-needed light on the health care cost mess.  There are a couple of other points that bear mentioning.  It’s not just patients that don’t know the cost of their care up-front; we doctors don’t know either, and it’s difficult for us to find out.  (Nor do most of us care so long as insurance or Medicare is paying the bill.)  Making things worse, in the name of being thorough, we doctors order scads of unnecessary and wasteful tests without regard to cost, many of these for elaborate investigations of stress-related complaints.  We doctors don’t think about cost until our patient looks us in the eye and says, “Doctor, I don’t have insurance.  What is this going to cost?” Insuring more people is not the answer.  It will simply throw fuel on the flames and speed us toward personal and national bankruptcy.
Ralph Retherford, M.D., Family Practice,
Sonora, Calif.

As President and Chief Executive Officer of a community hospital in small town America, I was impressed by Steven Brill’s naiveté, simplicity, and biased agenda related to healthcare costs.  Rising healthcare costs must be addressed from a broader objective perspective to include the accountability of the public we serve.  An assumption under the social contract is that the public also has accountability.  One needs to look at the demand for healthcare as a critical factor in the rising cost.  Hospitals across our nation are afflicted by moral hazard.  Many citizens use the local hospital Emergency Department as a 24 hour clinic knowing that by federal mandate hospitals must address their medical demands regardless of their ability to pay. The rising cost of healthcare is also reflection of the societal issues.  A case in point is the impact thatobesity has on the health status of our nation.  Another national issue is the rising epidemic of mental illness.  For many of these citizens there only rescue is the local hospital Emergency Department.  Again, a broader discussion from an objective perspective needs to occur if we are ever going to reduce healthcare cost.
Ed Piper, Ph.D.
President and CEO,Onslow Memorial Hospital, Jacksonville, NC

Steven Brill’s impeccably researched indictment of our health care industry gone haywire should lead to Congressional hearings where industry officials are forced under oath to justify their unethical and shameful gauging of the sick and vulnerable whom they’re hired to protect.
Allyson J. Kleiman, Lake Worth, Fla.

I can’t say I was shocked by the revealing feature section on America’s health care costs, but the excessive salaries of hospital administrators was totally outrageous.
Jordan Austin, Port Hueneme, Calif.

Steve Brill rendered an absolutely incredible article detailing the medical dilemma we face. We have an easy solution.Offer Medicare to everyone and offer no insurance payments to physicians; let them negotiate payment with patients for any and all services. Then eliminate Medicaid. Let Medicare pay hospitals. Costs will drop by over 50% in less than a year. Our “crisis” will be over.
Stanford A. Owen, M.D.
Gulfport, Ms.

I have been reading TIME magazine for something like 50 years, and in all that time I have never written to you.  But your March 4, 2013 cover story by Steven Brill is the finest, most well-informed, best-presented piece of investigative journalism that I haveever read. Please encourage this level of courageous, quality reporting.
Keith Doyon, Madison, Wis.

I have never before written a letter to the Time Magazine editor’s desk, but Steven Brill’s powerful piece of investigative journalism has prompted me to do so now.  I want to thank him for bringing this issue to the attention of the American people.  If there is an institution moredysfunctional than Congress, it has to be the U.S. health care system.  It is wrecking families and bringing down the national economy and something needs to done.  Is it too much to hope that a few of those who are at the top of the system reaping such ill-gotten gains from desperate people will actually reflect upon the monstrosity they have helped to create and sustain?  Will some physicians out there be reminded of their Hippocratic Oath?  Willpoliticians who have been on the fence due to the might of the health industry lobbies pluck up the courage to do what is right for the country? In the richest  country in the world, this is a truly shameful situation.
Dr. Gary Kline
Professor of Political Science
Chair, Department of History & Political Science
Georgia Southwestern State University
Americus, Ga.

(VIDEOThe Exorbitant Prices of Health Care)

Steve Brill’s article on why the U.S. spends so much on healthcare was a real eye opener. Please pass along mythanks to Mr. Brill for his many months of hard work and dedication to the American people.  I wish I could get everyone Iknow to read those 25 incredible pages.  I am trying! My next step today will be writing to my Senator and Representative to ask them when this economic fiasco will be cleaned up so that seniors such as I can cease becoming the scapegoats for Medicare costs and health care spending and the American taxpayers will cease carrying this enormous burden.
Marilyn Martin, Chesapeake Beach, Md.

I don’t write thank you notes on reporting. But I, and the rest of this nation, should thank TIME and Mr. Brill for doing the old-fashioned investigative reporting that matters in all the right ways. Mr. Brill’s piece reminded me of just how much we desperately need solid reporting in a nation where regular people are routinely disadvantaged. Getting to the heart of a story like this is hard work, telling it is hard writing, and reading the unnecessary and cruel mental anguish these folks are going through makes for hard reading. And all of that is essential to a functioning democracy.
Jackie Sartoris, Brunswick, Maine

The “Bitter Pill” article by Steven Brill (March 4th) was one of the most enlightening pieces of journalistic work ever to appear in a major publication.  And, congratulations to Time for devoting so much space for it.This careful analysis of the core failure in the delivery ofaffordable health care to all U.S. citizens today highlights the fact that “too much government” is not our main problem…an ineffective government is.  The blame can be laid directly at the feet of our elected officials, who continue to fail to produce legislation which benefits the electorate instead of special interest groups.
Robert Hughes, Goffstown, NH

There is an important fact about unsustainable hospital costs which Steven Brill in his excellent article in the March 4 edition did not identify, namely that hospital and overall costs have already been brought under control in delivery systems models in which there is a built-in financial incentive to minimize costs while maximizing quality. For example, in prepaid group practices like Kaiser-Permanente, an integrated system of ambulatory and hospital care with salaried physicians and other health care providers, the problems and abuses Brill identifies are absent. While the reforms Brill identifies are important , the crux of the problem, as I and many experts in the field read the evidence, is how the delivery system as a totality is structured.
Richard Feinbloom, M.D., Seattle, Wa.

About 40 years ago, I had a neighbor who worked in a hospital billing office. She once told me that, after the amount covered by insurance, they would often arbitrarily bill patients an additional amount that the patient was likely to pay but not too much more because if a patient protested they often had to reduce the bill. I didn’t give this revelation much thought until about 15 years ago when my wife and I became responsible for her elderly parents’ finances.  They were both approaching 90 and often needed hospital care. Although theywere on Medicare and also carried private insurance, almost every hospital visit was soon followed by a bill for an additional amount, usually under $100, for which we would write a check.
But there were several occasions in the next few years that they were billed for amounts well in excess of $100.  When that happened we would question the bill and, with one exception, were always given a refund with an apology and a reason such as the computer was down that day, a temporary employee had sent out the bill, etc.
Richard W. King
Pasadena, Tx

As a physician, I think this article raises many important points that warrant serious discussion. As an oncologist, I think there are many ways we can lower the cost of care, most of which will not compromise quality of care, and some of which may actually improve quality of care.  As a recent graduate of M.D. Anderson Cancer Center, I think there may be “more to the story” of this institution than this article reflects.   For two out of my threeyears of fellowship, I provided care for cancer patients through MDACC’s outreach clinic at Lyndon B Johnson Hospital.  Although there were many motivations behind the care delivered by the fellows, attending physicians,nurses, and support staff at LBJ, I can safely tell you that money was not one of those motivations. As fellows, we did well to stay on top of our student loan payments, rent, groceries, and utilities.  But we worked very hard for what we earned, and the long hours we spent in clinic seeing patients represented only a tiny fraction of that work.  Outside of clinic, all fellows were available by phone for our patients 24 hours a day, 7 days a weekI made house calls to patients who weren’t eligible for Hospice.  When my patient could no longer afford to pay his phone bill, I drove to his apartment to tell him that he had acute leukemia, and that we needed to start treatment the following day.   And my sacrifices were trivial in comparison to those made bysome of my attending physicians (all employees of MDACC), who literally dedicated their careers to delivering outstanding cancer care to patients who could otherwise not afford it.  I owe much of what I know about oncology to my teachers at LBJ, and I don’t just mean what I needed to know for a board exam.  They taught compassion through example, not because it was profitable, but because it was the right thing to do.
Patrick Archie, MD
Hematologist-Oncologist, Celilo Cancer Center
The Dalles, OR

MOREYour Hospital Bill Nightmares, via CNN iReport

33 comments
Tomster
Tomster

 I read this article last winter, and noticed the outrageous $18 charge that a hospital charged for a simple glucose blood check. I am a Type 1 diabetic and check my blood about seven times a day, which is what is recommended to keep your sugar level under control. Any check on Amazon or anywhere shows that test strips run about $.50 to $.70 per strip. I thought that only bad hospitals would dare charge that much. Well I just got my bill and there it was, $18 for a glucose test done at the doctors office. I totally lost all my respect for my doctor and all the medical community. I called every contact I could and voiced my outrage, but no one offered any explanation as to why this is justified. I really don't understand it. To rip off sick people in such a manner just seems so unethical, why isn't there more outrage and attempts to fix this horrible waste of healthcare dollars?  Has any progress been made on this issue?  Any?  Please?

BlessAmerica234
BlessAmerica234

People, stop being so arrogant.  We are the reason health care is so expensive!  We eat too many bags of chips, smoke and drink too much, and don't exercise.  These habits destroy our heart, lungs, bones, etc and force the medical community to come up with "cures" such as blood pressure/cholesterol medicine, coronary bypass, gastric bypass, joint replacement, stents and on and on.  Developing these remedies costs money, as does applying them.  Where there is a need there is an idea.  Its capitalism at its finest and is what makes America great.  Chris Christie got the Lap Band.  Why didn't/doesn't he just put down the cheeseburgers and fries.  No, that would be too hard, can't do that!  You will get your wish, healthcare will be made "affordable," but don't start crying when that CT scanner is no longer in your town and you have to travel to get it.  We take for granted all the care we have available but will lament the day it is gone.  It has to go, its unsustainable.



Ella01
Ella01

Excellent article!!  And like many people here, I usually don't say that.  Thank you for coming out and publishing what most of us knew deep down, but couldn't quantify.  Notice we have no elected leaders that are effective or courageous enough to say this either. Interesting that the Centers for Medicaid and Medicare have had this information for a long time and chose not to do anything with it to benefit the American people or actually help solve a deep problem in this country.  Now Mr. Brill, please do this again for Big Pharma!!  

PeterD.Mikkelsen
PeterD.Mikkelsen

TIME should, as a matter a national interest, make the entire 26,000-word article available to the public -- free of charge.

dave9000
dave9000

Ed Piper is a real piece of work. Mr. Brill's exceptional reporting exposes the truth of the emperor's clothes and Mr. Piper wants us all to admire the emperor's ascot while he dips his fingers into our wallets. I'm guessing Mr. Piper is one of the grossly overpaid "administrators" excoriated by Mr. Brill's outstanding article.

robertpetrillo
robertpetrillo

In response to “Bitter Pill,” what no one is acknowledging is the elephant in the room.Almost everyone seems to agree that a combination of opacity of charging procedures at hospitals, overly high remuneration for administrators and lobbyists, and labyrinth and needlessly duplicative policies of so many insurance companies all contribute to the dysfunctional miasma we call national healthcare.

 If we were to establish a realistic range of prices for various procedures and drugs, and compensate healthcare providers according to a uniform scale (like union carpenters, say), the federal government (working along with states) could operate way more efficiently with a lot less confusion.Sure, there will always be bureaucratic tangles, but over all programs like Medicare and social security seem to be doing OK, especially when compared to the alternative.

 So the elephant?It’s what to do with all the unemployed insurance company workers.Well, and maybe the overly generous campaign contributions from insurance, pharmaceutical, and medical lobbies to Congress.

cliffnorman
cliffnorman

Brill has provided a great public service. People in Congress who voted to excuse the drug companies from participating in the marketplace with CMS should be run out of office; Democrat or Republican. A read of Goldhill's new book Catastrophic Care is also in order. Goldhill observes that when gas PRICES increased people were up in arms during 2008. At the same time, health care COSTS were also increasing at an alarming rate. Why do we call one PRICES and other COSTS? When the word PRICE is used, people want to know what is going on. When the word COST is used, it all seems inevitable. The language has put people to sleep. Thanks Brill for waking us up. We need more journalists doing this kind of work and less of the partisan ignorance that occupies most of the media; both right and left.

TomWiedell
TomWiedell

Great article.  As a hospital medicare auditor (2 years), assistant controller (5 years), health system corporate office financial analyst (5 years), health system regional finance director (5 years), hospital director of billing and reimbursement (6 years), and hospital CFO (14 years) I can tell you this is only the half of it.  The stuff I've witnessed some (not all) healthcare CEOs and CFOs do would rival the Enron debacle.  There's way too many executives in healthcare that should be working in another industry because they really could give a rip about the patient, it's all about their personal salary and power.  Having said that, some of the finest, most ethical individuals one will ever meet are working in our healthcare system both in the administrative and clinical side.  I say throw the scammers and manipulators out!

billsincl
billsincl

I was admitted to Providence Little company of Mary hospital for food poisoning last November. Despite the fact that I was there for only ONE DAY, they submitted a bill to Medicare for $17300. Medicare knocked that down quite a bit, but the hospital put "self administered" medications on my bill totaling $439, which Medicare does not cover. They were NOT prescribed by any doctor. These were medications I did not ask for, did not need, and never received. In other words, they were put there just for THEIR PROFIT MOTIVE. I told them they would have to sue me to collect that amount, since I feel it was FRAUD.

This is an example of how these hospitals treat their patients, not as people needing medical care, but as a CASH COW.

walker.steve70@gmail.com
walker.steve70@gmail.com

As shocking as it may seem,  Mr Brill cements the conclusion that the most efficient system we have is Medicare, 

an operation fully run by our federal government.  

walker.steve70@gmail.com
walker.steve70@gmail.com

Mr. Brill's article on health care fraud in this county is the most well researched and thoroughly supported popular journalism

I have read in years.  It is Pulitzer worthy.   I am pleased to read of the surge of the industry of professional, knowlegeable

appeals agents that are available to the victims of this perversity.   Mr Sayfer of  Montefiore Medical, who is cited as being paid

$ 4 million annually, should be more concerned about explaining the paltry 7.6% operating profit of  his institution vs the national

average of 11.7% than he is about justifying the abuse being forced upon his community.    Long after the benefits of ObamaCare are

forgotten, the nation will remember that this legislation missed our #1 national problem which is the obscene cost of care.

DanielClayton
DanielClayton

I think it is truly hard for us to divorce our political ideals from a healthcare conversation. However as a healthcare internal auditor there are some important factors that over the years have broken natural markets for generating high quality cost effective care. Natural markets can work in health care, but these factors have to be better addressed.

1. Since 1966 CMS Regulators have been setting the prices they will pay on a fee for service basis, promoting volume of care over cost effective quality in the incentives to Hospitals and Care Providers

2. Stark and Anti-kickback Laws make it illegal for Doctors to play a prominent role in owning and administering the whole cycle of care, for fear they will inappropriately refer care to themselves. While the fear is real, it removes the most knowledgeable resource from having an impact on defining or being invested in the care processes. 

3. Patients Rights to low co-pays and ability to walk away from healthcare bills without serious consequences; some credit agencies give healthcare debt little credit score impact. In some states more than 75% of Americans never pay their co-pays and deductibles. By contrast patients with high deductible health plans (and not indigent) spend much less on healthcare as more comes out of their pockets when they do. This self regulation also leads to personal investment in dietary, fitness and alternative methods of care that has little investment today. Yet regulation protects the patient low to no pay process defeating the financial incentive for personal accountability of health care.

4. Doctors have resisted CMS and other call for quality factors noting that they treat sicker patients and will be penalized if paid on outcomes. In reality big data can define quality of care and one of the potentially best governmental investments will likely be the $20B HITECH spent on promoting electronic health records. 

5. Finally, lawyers who fill the halls of congress always love the little guy and want a wide scope of law in which to protect them. However today in some instances doctors and hospitals can be sued regardless of making choice A or choice B. This has lead to malpractice insurance that exceeds most Americans monthly mortgage and shrinking doctor reimbursement. The concerning impact has been the exodus of the general care practitioner. Today Medical schools are full of students going into one specialty or another with less risk and more income. It is no wonder that the care is inefficient when no doctor takes ownership or is rewarded for the whole continuum of care.  

In this environment where the patients and doctors are incentive's to run every test, see every specialist, try every drug it is no wonder we are spending the national treasure. Device manufactures and drug reps need only convince the doctor or patient that of their brand not their cost. One Drug rep recently noted he sells a drug that has received a 10% markup each year, with not resistance even though there is a generic on the market at 8% of the cost. This can be remedied, but that remedy begins with putting all regulation on the table, and placing power to make things better in the hands of those with knowledge and accountability. 


jimnewfy
jimnewfy

Well written but sad commentary on the health of  health care industry.  Like most, I'm just your average Joe Plumber trying to make a living (after closing my constructon company) and get the kids thru college.  And like many Americans just one health related issue away from bankruptcy.   I wish those that are a part of the medical machine would promote change from within, headed by the medical doctors that have the most clout, which would begin to change the out of control medical costs.   Unfortunately, when all is well in the medical industry and one is making a great living, made possible by the rest of us, there isn't a lot of will for change.  All is well with medical salaries and benefits for those connected to this industry, damn the rest of us.  I wish there were a level playing field for all of us, but there isn't, Congress has no backbone to face up to our impending medical crisis, apparently there are too many medical industry lobbyist stuffing wads of cash into the pockets of our Congress men and women.  I am outraged by the medical industry, I wish those on capital hill would be outraged as well, then they might face up to this issue.  Jim Neufeld

erdoc2009
erdoc2009

As an ER doctor of over 10 years, I have watched the system fail and fail and fail some more.  Steve Brill gets to one of the biggest problems in healthcare -- cost.  And the lack of transparency.


About a year ago, instead of watching it continue to collapse, we took on the challenge of bringing transparency to the system and we created an Amazon-like portal to provide for upfront pricing with transparency to know what you're getting and what you're going to pay.  Nearly 200 physicians have joined us as well as being able to over nearly 500 tests - imaging, blood, etc - the Time Magazine article put on the national stage what we already knew - that empowering patients with real pricing information and bringing that into the discussion with their doctor and raising that real cost-saving question:  "do I really need this?  Given what it costs, what will it tell you and how does it help?"  That microcosm will really bring healthcare costs into check and balance in a way that maintains the doctor-patient relationship.


Take a look at what we've done -- and join our pursuit to bring transparency to the system -- www.snaphealth.com  -- we've launched in Houston already - ask your doctor to come on to our platform and help healthcare make sense.


David Wong, MD
Co-founder - SnapHealth.com

michaelalex
michaelalex

This is an extremely important article. Why hasn't it triggered a national debate? Congress is back to the old debate; who should pay for health care costs. As Mr. Brill makes abundantly clear we should be addressing why our health care bills are so high.


Michael Feirstein

JimRecht
JimRecht

After providing nearly 20 pages of damning evidence -- against both the excesses and inefficiencies of the private health insurance industry, and the runaway profiteering of hospitals, pharmaceutical and device manufacturers -- author Brill arrives at the obvious point: that is, “the best way both to lower the deficit and to help save money for people” is “the single payer approach ... used by most developed nations.” Here he is right on the mark. But then abruptly, having just provided an argument that clearly supports it, he dismisses this conclusion. He provides two reasons for backing away from single payer: first, “no doctor could hope for anything approaching the income he or she deserves (and that will encourage future doctors to want to practice).” Second, “this kind of systemic overhaul ... seems unrealistic” given the extraordinary political power and influence of the health care industry.

The first assertion is factually incorrect. In fact, most doctors would earn the same under a single-payer system as they do now. The main difference in the professional life of myself and of tens of thousands of physicians like me would be freedom from the unimaginably exhausting and time-consuming demands of private insurance company rules and regulations. For those doctors whose high incomes ($1 million or more annually) result from billing for individual procedures like cardiac catheterization and joint replacements, incomes would likely suffer somewhat, but would certainly remain in the mid- to high-five figures. It’s hard to believe that as a nation, we would reject such urgently needed reforms simply to protect these multimillion-dollar salaries.

The second assertion -- that it “seems unrealistic” for Medicare to be improved and expanded to include comprehensive coverage for all Americans -- is logically flawed. Brill himself admits that the halfway measures he goes on to propose are similarly “unlikely to happen” given the current political power structure. Beyond this, if our society had followed his logic in 1917 or 1954, today we’d be living in a country where women were forbidden to vote and where schools were separated by race.

mikhaelburke
mikhaelburke

I read Dr. Piper’s response to the Bitter Pill article in Time Magazine. I don’t understand how he can confound “the accountability of the public we serve” with a $77 fee for a box of sterile gauze pads or a charge of $1.50 for a single 500 mg dose of acetaminophen. If no one was obese, everyone exercised regularly, no one smoked, and we all ate a Mediterranean diet, would hospitals lower the fees on their chargemasters?  

josrichdon
josrichdon

It is illogical to allow profit to be part of any system to avoid suffering and death. Like the Mafia  big.business will use the inherent leverage to extort a price most cannot afford, but must still pay. 

19lin
19lin

I enjoyed  Brill's article and feel it is on target.  I still think we need some kind of minimum national health care, but change malpractice to be more reasonable.  My mother suffered terribly with cancer,, but my parents had no major insurance and she died two weeks after her 65th birthday.  In addition the law on bankruptcy needs to allow for medical and divorce instead of making  a person with any income to have to pay for the rest of their lives or go to prison.  One  thing not stated enough is nursing homes which are often owned by medical people that will take everything you have from you.  This conflict of interest needs to be addressed.  Also euthanasia needs to be allowed nation wide and not just in the last few months of life.  If a person can not have their health returned they need to be able to decide their own fate instead of being forced to stay alive and suffering so nursing homes and the medical system can drain every dollar out of them.  

josrichdon
josrichdon

I am a health care industry investor and unlike those who care for people, I do not.; I care for profit. And the CEOs of the health care companies in which I invest, work for me, the stock holder. Our goal is to make the most money we can, while providing service in a way that keeps us in business and within the law as our attorneys interpret it.   Why is there such shock when it is discovered that profit drives our policies and practice, rather than what is good for patients and the nation.

The old time highway robbers used say "Your money or your life" and many of them were caught and hung. The for profit healthcare vultures can take your money and your life, and remain respected pillars of the community.   Our nation has socialized military, socialized police departments and socialized court systems, because we know that if those institutions were profit based it would subject America to great harm and expense perpetrated by people like me. For profit health care is no different.

satish.rahi
satish.rahi

Great article. It does not elaborate role of Insurance companies (especially workman's comp and Traveler). It does look like who ever can loot the system ...does. Be it Hospitals, Pharma, Insurance and even lawyers and physicians.   

engund
engund

And yet, a first year resident in New York City will this year will make less than $60,000 a year, possibly carrying $200,000 in debt, while a first year associate at a New York law firm will earn as much as $175,000 a year.

ChipWagar
ChipWagar

As a medical malpractice lawyer, Steve Brill's article was like a crackling thunderbolt across the medical sky.  It should not only illuminate but detonate Congressional inquiry into an industry managed with breath-taking greed.  The description of the desperate patients, many middle or upper-middle class, but without insurance or medicare was particularly touching.  The life savings of these middle class people exhausted and driven to bankruptcy while hospital executives lap up 7-figure salaries and create new medical monopolies.  My only critique on a Pulitzer-worthy expose was the gratuitous journalistic bow to the hackneyed excuse served up by these same greed-mongers that the reason they order unnecessary tests and procedures is due to fear of lawsuits and lawyers.  This from a profession and industry that collectively may be responsible for the third leading cause of death in the United States:  medical error.  This from a profession and industry that ceaselessly promotes damages caps and other preferential judicial treatment for themselves in tort reform campaigns in state legislatures at the expense of their severely crippled victims or bereaved families of the dead.  No, the reason for the unnecessary tests, other than incompetence or malpractice, is for the direct financial benefit of the physicians, hospitals and healthcare facilities that order or provide them.  

mawsonii
mawsonii

I believe that Steven Brill's article merits the addition of a new term to the Diagnostic and Statistical Manual of Mental Disorders (DSM):  medaphilia, a paraphilia in which the agents of a health care organization have recurrent, intense pseudosexual urges or pseudosexually arousing fantasies of repeatedly engaging with uninsured or underinsured or poor or soon-to-be-poor sick persons or other blindly consenting partners, without regard to their pubertal status, having never or only incidentally laid eyes upon their victims, with the intent of reaping salacious salaries.

kristaavril
kristaavril

This was a wonderful, albeit disturbing article. I'm fascinated by the criticism from the hospital CEO. The best he can add to this incredibly important issue is to attack and blame the poor, obese, and mentally ill? Does Ed Piper really believe that those who rely on the ER have any other choice? If so, I don't think he belongs in that job.

ScottLynch-Giddings
ScottLynch-Giddings

Of these 22 letters of praise for Steven Brill's astounding, maddening, utterly praiseworthy article, the lonely exception of snide criticism comes from the CEO of a hospital.  Figures.  It doesn't surprise me that Ed Piper can't see over his overfed wallet to perceive the big picture.  What bothers me is that this Ph.D. CEO doesn't know the difference between "there" and "their."  His advanced degree is certainly not in English.  Or Ethics.

RebekkahDBazley
RebekkahDBazley

Insurance companies do for individual patients what unions do for individual workers, collective bargaining.   Unfortunately, unlike unions, most insurance companies are publicly traded, or at least for-profit, entities.  The problem is that PROFIT really has no place in the world of MEDICINE. 

Rebekkah Dellaccio-Bazley, RN BSN MBA

MaryMassery
MaryMassery

Best, and the most important article that I have ever read in Time.  Steven Brill for President!!!


Tomster
Tomster

@BlessAmerica234 I just had to respond.  People can take care of themselves all they want and still get sick.  Why is legal or tolerated for a doctor to mark-up a $.50 glucose test strip to $18?   Why, except to screw sick people who don't have any option to shop around.  Why am not I allowed to set up a little stand in the hospital to check people's sugars and pocket that $17.50 myself? 

LanceCook
LanceCook

@BlessAmerica234"don't start crying when that CT scanner is no longer in your town and you have to travel to get it." Shoot, I already don't have access to the CT scanner. I tried to get my doctor to get my aching shoulder CT scanned but he wouldn't let me since my insurance was to cheap and he knew I couldn't afford it on my own. So now I just live with an aching shoulder and don't know what's wrong with it or what I can do for it. Great healthcare system, huh? We should just ditch the insurance companies.

erdoc2009
erdoc2009

@michaelalex Agreed!  Obamacare fails in one of the most important issues -- bringing down costs.  The national discussion can't end - it needs to get going - because the biggest problem still hasn't been fixed!

erdoc2009
erdoc2009

@ChipWagar While I agree that Brill's article exposes one of the biggest problem in healthcare, I hope ChipWager understands that he's directly involved with the other problem - a broken malpractice system -- causing doctors to over-test out of defensive medicine.

erdoc2009
erdoc2009

@kristaavril As an ER doctor of over a decade, we decided to create a choice -- seeing what the problem was - we've created an upfront pricing platform that makes care more affordable - we've had many patients use our platform, we have nearly 200 doctors, nearly 500 tests - we've launched in Houston - we're trying to change the world.   www. snaphealth.com