TL: Why haven't reporters tackled more of the healthcare business
angle?
SB: In some cases they are intimidated.
TL: Reporters sometimes complain about lack of access to top
hospital officials, and in your Time
piece you noted many of those high officials did not talk. How much is this a
barrier to good reporting on hospitals?
SB: You are mis-defining access. Access isn't, in this case, about talking to
the CEO of a hospital. It's about getting the bills. It's about getting their
publicly available financial reports. About getting the insurance companies'
explanations of benefits that they give to patients. Or the cost data the
hospital has to file with CMS. In that sense, I got all the information I
wanted. I was buried in access--three file cabinets full by the end. If a
reporter says, "Gee, I emailed the president of a hospital and he didn't answer
my email,' that's not the kind of reporter you want on your staff.
TL: Where should reporters take the healthcare story now?
SB: A story like the one I wrote can and should be written in every
community in the US. For example, I just scratched the surface on lab fees and
diagnostic tests. Why do we order so many tests? You can't do enough of this
kind of reporting. Journalists have been derelict, but there also great
opportunity. Every hospital, every lab, every drug company has a story, and the
data are accessible if you're willing to spend the time and play with it.
TL: You note in your piece that hospital consolidation will end up
raising the cost of care. How would you push back against the market power of
the hospitals, the way governments in countries with national health systems
do?
SB: There are lots of ways. First is complete transparency, so you know
what you're arguing over. You could simply say all prices have to be
transparent, and no provider could vary the price by more than 10 percent. You
could require all hospitals to charge the same prices for the same procedures.
You could allow them to charge 140 percent of what Medicare pays. You could
divide healthcare services into two types--voluntary and involuntary. Voluntary
services would be things like Lasik or cosmetic surgery. Involuntary services
are those you wouldn't choose to do unless you have to. The prices for these
things have to be regulated.
TL: What about regulating profits?
SB: You could limit their profits to five percent, and anything more than
that, they would have to put back in the system by providing more free care, or
paying a tax. Once you realize that the price of care is too high, you can
regulate the prices you can charge.
TL: What are the chances of this happening?
SB: I can say now they are slightly more than nil. It can become a
significant issue politically. There will be some change because the healthcare
industry has priced itself into the political arena.
TL: Can states lead the way?
SB: Yes. Maybe there could be 46 or 50 Marylands, a state with price
regulation.
TL: How far can transparency go to move the needle?
SB: It can only go so far. It's good that chargemaster prices have now been
made
public by Medicare. Knowing what hospitals charge insurance companies would
also go a long way. There's no reason why a state can't disclose those charges.
Once you have that information, that's good. But it's only the beginning of the
conversation. Transparency and skin-in-the-game is a way to begin the
conversation, but it's not the answer. Until patients have leverage--which they
never will--you're not going to change medical pricing. The only way to control
medical prices is how every other country does it. The market can't work
without government regulation.
TL: What are the shortcomings of the Affordable Care Act, in your
view?
SB: It nips at the edges but doesn't address the basic problem of the cost
of healthcare. It deals with who pays the costs, not what the costs are. The
law passed precisely because it doesn't solve the problem
*Steven Brill's Time Magazine article is currently available on the internet only to Time online subscribers. You can access Trudy Lieberman's review of the original Brill article here (Op Ed News) and here (Columbia Journalism Review). The re-post at Op Ed News is still generating hundreds of hits each week, more than four months after it was posted.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
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