Steven Brill has achieved the seemingly impossible—written an exciting book about the American health system. In his account of the passage of the Affordable Care Act (now known as Obamacare), he manages to transform a subject that usually befuddles and bores into a political thriller. There was reason to think he might pull it off; his lengthy 2013 Time magazine exposé of the impact of medical bills on ordinary people was engrossing. But his success also owes much to the Bob Woodward method of writing best sellers about government policy: interviews with hundreds of insiders, many anonymous, some evidently willing to talk to him to increase their chances of being shown in a favorable light.
For example, one of Brill’s principal sources and a great favorite is Liz Fowler, chief health counsel to Senator Max Baucus, chairman of the Senate Finance Committee, which oversaw the legislation. Brill credits her with being “more personally responsible than anyone for the drafting of what became Obamacare.” He is unbothered by the fact that she was vice-president for public policy at WellPoint, the country’s second-largest private insurance company, before taking her job with Senator Baucus, or by the fact that shortly after passage of the law (and a brief stint with the administration), she became head of global health policy at the drug company Johnson & Johnson—even though both of these industries benefited greatly from Obamacare. (...)
Here are a few items in Brill’s indictment. “Healthcare,” he writes, “is America’s largest industry by far.” It employs “a sixth of the country’s workforce. And it is the average American family’s largest single expense, whether paid out of their pockets or through taxes and insurance premiums.” He estimates that the health insurance companies employ about 1.5 million people, roughly twice the number of practicing physicians. Hospital executives preside over lucrative businesses, whether nominally nonprofit or not, and are paid huge salaries, even while they charge patients obscene prices (Brill cites $77 for a box of gauze pads) drawn from “what they called their ‘chargemaster,’ which was the menu of list prices they used to soak patients who did not have Medicare or private insurance.” He tells us that the CEO of New York–Presbyterian Hospital, where he had major surgery shortly after his article appeared in Time, had an income of $3.58 million. And finally, he gives us the really bad news: “All that extra money produces no better, and in many cases worse, results.”
When Barack Obama became president in 2009, reforming the American health system was at the top of his domestic agenda—ahead even of the banking crisis, housing foreclosures, and unemployment. And he was candid about the reason: soaring health costs were undermining nearly everything else. As examples: Medicare—the government program for Americans over age sixty-five—was a growing contributor to federal deficits; businesses that offered health benefits to their workers were at a competitive disadvantage, both domestically and globally; workers were afraid to leave jobs because they would lose health insurance if they did; and medical costs had become the chief cause of personal bankruptcy. In short, the American health system was no longer supportable.
When Obama was a state senator in Illinois, he was on record as favoring a single-payer health system—that is, one in which the government ensures health care for all residents of the country and regulates the distribution of resources in a predominantly nonprofit system. That’s the sort of system every other advanced country has. Even after he became president, Obama acknowledged in a press conference on July 22, 2009, that a single-payer system was the only way to achieve universal health care. Even so, except for that one admission, there was no further consideration of single-payer health care—by Obama or, crucially, by Senator Baucus—during the year Obamacare was crafted.
Instead, the launch of the reform effort was a White House media event in March 2009 that featured spokespersons for the for-profit health insurance and pharmaceutical industries, who pledged to work with the president to reform the system. But not for nothing. As a condition of its support, the insurance industry demanded that all Americans—except those in Medicare and other government programs—be required to purchase private insurance. The central role of the insurance industry would thus be not only preserved, but expanded and enshrined by law. As a condition of its support, the pharmaceutical industry demanded the continuation of two laws that Obama, as a candidate, had promised to try to overturn—one that forbids Medicare from using its purchasing power to control drug prices, and another that forbids Americans from importing cheaper drugs from other countries.
After these deals were struck, there followed a year of congressional wrangling, replete with further deals to mollify conservatives and the health industries. For example, the idea of a “public option,” that is, government-sponsored insurance to compete with private insurers, was scuttled. The final product—the Patient Protection and Affordable Care Act—was signed into law on March 23, 2010, and scheduled to go into effect over ten years, with the major provisions in effect by 2014. (...)
by Marcia Angell, NY Review of Books | Read more:
Image: John Springs
For example, one of Brill’s principal sources and a great favorite is Liz Fowler, chief health counsel to Senator Max Baucus, chairman of the Senate Finance Committee, which oversaw the legislation. Brill credits her with being “more personally responsible than anyone for the drafting of what became Obamacare.” He is unbothered by the fact that she was vice-president for public policy at WellPoint, the country’s second-largest private insurance company, before taking her job with Senator Baucus, or by the fact that shortly after passage of the law (and a brief stint with the administration), she became head of global health policy at the drug company Johnson & Johnson—even though both of these industries benefited greatly from Obamacare. (...)Here are a few items in Brill’s indictment. “Healthcare,” he writes, “is America’s largest industry by far.” It employs “a sixth of the country’s workforce. And it is the average American family’s largest single expense, whether paid out of their pockets or through taxes and insurance premiums.” He estimates that the health insurance companies employ about 1.5 million people, roughly twice the number of practicing physicians. Hospital executives preside over lucrative businesses, whether nominally nonprofit or not, and are paid huge salaries, even while they charge patients obscene prices (Brill cites $77 for a box of gauze pads) drawn from “what they called their ‘chargemaster,’ which was the menu of list prices they used to soak patients who did not have Medicare or private insurance.” He tells us that the CEO of New York–Presbyterian Hospital, where he had major surgery shortly after his article appeared in Time, had an income of $3.58 million. And finally, he gives us the really bad news: “All that extra money produces no better, and in many cases worse, results.”
When Barack Obama became president in 2009, reforming the American health system was at the top of his domestic agenda—ahead even of the banking crisis, housing foreclosures, and unemployment. And he was candid about the reason: soaring health costs were undermining nearly everything else. As examples: Medicare—the government program for Americans over age sixty-five—was a growing contributor to federal deficits; businesses that offered health benefits to their workers were at a competitive disadvantage, both domestically and globally; workers were afraid to leave jobs because they would lose health insurance if they did; and medical costs had become the chief cause of personal bankruptcy. In short, the American health system was no longer supportable.
When Obama was a state senator in Illinois, he was on record as favoring a single-payer health system—that is, one in which the government ensures health care for all residents of the country and regulates the distribution of resources in a predominantly nonprofit system. That’s the sort of system every other advanced country has. Even after he became president, Obama acknowledged in a press conference on July 22, 2009, that a single-payer system was the only way to achieve universal health care. Even so, except for that one admission, there was no further consideration of single-payer health care—by Obama or, crucially, by Senator Baucus—during the year Obamacare was crafted.
Instead, the launch of the reform effort was a White House media event in March 2009 that featured spokespersons for the for-profit health insurance and pharmaceutical industries, who pledged to work with the president to reform the system. But not for nothing. As a condition of its support, the insurance industry demanded that all Americans—except those in Medicare and other government programs—be required to purchase private insurance. The central role of the insurance industry would thus be not only preserved, but expanded and enshrined by law. As a condition of its support, the pharmaceutical industry demanded the continuation of two laws that Obama, as a candidate, had promised to try to overturn—one that forbids Medicare from using its purchasing power to control drug prices, and another that forbids Americans from importing cheaper drugs from other countries.
After these deals were struck, there followed a year of congressional wrangling, replete with further deals to mollify conservatives and the health industries. For example, the idea of a “public option,” that is, government-sponsored insurance to compete with private insurers, was scuttled. The final product—the Patient Protection and Affordable Care Act—was signed into law on March 23, 2010, and scheduled to go into effect over ten years, with the major provisions in effect by 2014. (...)
Practically every serious economic analysis of the American health system has concluded that the most efficient way to provide care to everyone is through some form of single-payer system, such as Medicare for all, and that any other approach will eventually be unsupportable. Why, then, was a single-payer system excluded from consideration and its proponents almost entirely barred from the discussion during the year Obamacare was written? That rejection can only reflect the enormous power of the health industry, which Brill reminds us has the largest lobby in Washington, D.C., and gave millions in campaign contributions to the key legislators. Indeed, Senator Baucus received more money from the health industry that year than anyone else in Congress.
by Marcia Angell, NY Review of Books | Read more:
Image: John Springs
