In the current issue of Time, Steven Brill — founder of Court TV and The American Lawyer — has a report that is over thirty pages long, running 24,000 words, on the state of our nation’s health care. It is the kind of investigative report that good journalists used to do, and has been absent far too long from American journalism. If it wins the Pulitzer Prize, Brill and the magazine’s editors will have rightfully earned it. It proves that in some regard, the mainstream media is not dead yet.
The report is not an ideological screed in which the author writes to either support or oppose Obamacare. Rather, Brill travels throughout the nation simply to explore why health care costs so much. He goes to hospitals and doctors’ offices, and he visits individuals whose lives have been ruined by the cost of the care they had to have. He argues that America does not have a health care system based on the free market, in which individuals have a choice about which product to purchase and what vendor to go to. Instead, he argues that health care is a seller’s market — often a monopoly — in which the prices of products they sell have no relationship to the actual cost.
Here are some examples from Brill’s article: Acetaminophen — Tylenol being the most well-known brand — is marked up 10,000% when a hospital patient gets a pill. Niacin costs five cents per pill at a drugstore; hospitals charge $24.00. And with Medicare, the taxpayer picks up the entire tab, medication being just one part of a giant bill.
I am not a policy wonk, and I hope that Yuval Levin or James Capretta, the two best conservative analysts who write for National Affairs and other publications, will address some of the issues Brill raises. Conservative critics will undoubtedly differ with some of Brill’s suggested remedies and agree with others, but his solid report and the facts he presents are inarguable. Our health care costs exceed that of all the other advanced nations, and they are far out of line with the actual costs of the product that is dispensed.
The main find that Brill presents is something few of us have previously been aware of: a list referred to by those in the know as “the chargemaster.” This is the private internal price list for products and services that every hospital administrator has in his or her office.
If you have private insurance or Medicare, what you pay will come far from the price listed on this secret internal list. If you do not have insurance, or have a bad policy, the hospital will try its best to make you pay close to the price on their list, regardless of whether or not it is based on reality.
I urge everyone to read Brill’s entire piece. There is no way an article of this depth or length can be summarized. As he goes through his research, there are moments in the article in which he shockingly — for liberals — praises the approach taken by Republicans and conservatives. On the issue of malpractice suits and the need for reform, he asks: why are so many CT scans given to patients when evidence indicates they are not needed? Why did one patient receive a nuclear-imaging test rather than a less-expensive stress test? The answer is the “defense” strategy — the need to avoid malpractice suits. The hospital can say they administered every possible test and are not responsible if a patient dies. Brill writes:
The most practical malpractice-reform proposals would not limit awards for victims but would allow doctors to use what’s called a safe-harbor defense. Under safe harbor, a defendant doctor or hospital could argue that the care provided was within the bounds of what peers have established as reasonable under the circumstances. The typical plaintiff argument that doing something more, like a nuclear-imaging test, might have saved the patient would then be less likely to prevail.
When Obamacare was being debated, Republicans pushed this kind of commonsense malpractice-tort reform. But the stranglehold that plaintiffs’ lawyers have traditionally had on Democrats prevailed, and neither a safe-harbor provision nor any other malpractice reform was included.
Later, Brill writes:
Finally, we should embarrass Democrats into stopping their fight against medical-malpractice reform and instead provide safe-harbor defenses for doctors so they don’t have to order a CT scan whenever, as one hospital administrator put it, someone in the emergency room says the word head. Trial lawyers who make their bread and butter from civil suits have been the Democrats’ biggest financial backer for decades. Republicans are right when they argue that tort reform is overdue. Eliminating the rationale or excuse for all the extra doctor exams, lab tests and use of CT scans and MRIs could cut tens of billions of dollars a year while drastically cutting what hospitals and doctors spend on malpractice insurance and pass along to patients.