In his “Stories I’d like to see” column, journalist and entrepreneur Steven Brill spotlights topics that, in his opinion, have received insufficient media attention. This week, he instead discusses how he got his recent story. This article was originally published on Reuters.com.
For the past 10 days I’ve been interviewed on various television and radio shows about the article I wrote for the March 4 issue of Time, called “A Bitter Pill.” It’s all about how exorbitant prices and profits are at the core of the crisis America uniquely faces when it comes to financing healthcare, the cost of which now accounts for roughly a fifth of our gross domestic product. The article took a new approach to reporting on an overreported issue by avoiding “on the one hand, on the other hand” policy analysis. Instead, I took actual medical bills and dissected them line by line.
Invariably a question has come up in these interviews about how I thought of that approach. So, since this is supposed to be a column about good story ideas, I think I’ll use it to explain the genesis of “A Bitter Pill” in more detail than I’ve been able to on the talk show circuit.
I always tell the students in a journalism seminar I teach at Yale that the best stories come from what you’re most curious about. Because I’m interested in business (as well as legal and political issues), questions about business and money often are what make me most curious, sometimes to the point of idiosyncrasy. For example, when I read last week that Jeff Zeleny, a star political reporter for The New York Times, had been hired away by ABC News, one of my first thoughts was that I’d like to see a story detailing how much more money he’ll be making — I bet it’s as much as twice his Times salary — and perhaps analyzing whether for Zeleny and other journalists his move represented a wrenching market misallocation of talent, given that his work is likely to have more impact, not to mention space, in the Times than on network television.
Similarly, during the long debate over President Barack Obama’s health insurance reform proposals, a question kept nagging at me: Everyone on all sides seemed to accept as a given that healthcare was wildly expensive, and the only debate seemed to be over who should pay for it. I wondered: Well, why is it so expensive in the first place?
At about the same time, a relative suffered a series of medical crises that produced hundreds of thousands of dollars in bills. For him, it was no problem because he had Medicare and terrific insurance to supplement what Medicare didn’t cover, leaving him on the hook for just a few hundred dollars. But again, I wondered, why were the bills so high?
What finally got me to act on that curiosity and turn it into a reporting project was a chance event, which I recounted in the Time article as follows:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson [Cancer Center] is the lead brand name. Medicine had obviously become a huge business. (In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies.) How did that happen, I wondered. Where’s all that money coming from? And where is it going?
I had no idea what the answers were. But it seemed obvious that there was only one way to find out: If you want to know why something is so expensive, figure out every element of its costs. In other words, follow the money.
Mr. Brill,
I enjoyed your "Bitter Pill" article, although like many others on the Left, I was confused by your policy prescriptions found at the end, which seemed to be at odds with what you had been saying in the rest of the piece. I wonder if you could respond to what Matt Yglesias wrote about this:
"I can see two reasonable policy conclusions to draw from this, neither of which Brill embraces. One is that Medicare should cover everyone, just as Canadian Medicare does. Taxes would be higher, but overall health care spending would be much lower since universal Medicare could push the unit cost of services way down. The other would be to adopt all-payer rate setting rules—aka price controls—keeping the insurance market largely private, but simply pushing the prices down. Most European countries aren't single-payer, but do use price controls. Even Singapore, which is often touted by U.S. conservatives as a market-oriented forced-savings alternative to a universal health insurance system, relies heavily on price controls to keep costs down.
For reasons I do not understand after having read the conclusion twice, Brill rejects both of these ideas in favor of meaningless tinkering around the edges. He wants to alter medical malpractice law, tax hospital operating profits, and try to mandate extra price transparency. That's all fine, but it's odd. His article could not be more clear about this—health care prices are high in America because, by law, we typically allow them to be high. When foreigners force prices to be lower, they get lower prices. When Americans force prices to be lower (via Medicare), we get lower prices. If we want lower prices through new legislation, the way to get them is to write laws mandating that the prices be lowered."
#1 Posted by Gzoref, CJR on Wed 6 Mar 2013 at 02:36 PM
To Steven Brill--As a private citizen I would like to refer to the coding list Medicare uses to check a hospital bill. The hospital provides a detailed bill(but only uponrequest) It contains codes and abbreviations that mean nothing to . How can I help spot billing errors if I dont have all the information? I contacted Medicare but they could not help me and referred me back to the hospital.
#2 Posted by CHANCY MORGAN, CJR on Tue 12 Mar 2013 at 03:57 PM