It might be said that last year Americans finally began paying attention to the price of their healthcare. Maybe it was the focus on Obamacare, or the Great Cost Shift and the realization they now had to pay more of these out-of-the-ballpark prices themselves. But journalism deserves a lot of credit, too, for shattering that long-held, erroneous belief that whatever we pay is justified because we get high quality care in return. From work in legacy media—like Elisabeth Rosenthal’s ongoing New York Times series, “Paying Till It Hurts” and Steven Brill’s 2013 opus in Time—to social media like Reddit—from which a 20-year-old outraged Californian’s $55,000 bill for an appendectomy went viral late last year—journalism is helping the public realize the cost of care is simply too high.
I sat down with the Times’ Rosenthal, herself an emergency room doc, to talk about what journalists and the public can learn from her series, which began early last year and so far has included six major pieces and more than 10 follow-ups.
What inspired the series?
I was covering international environment and had just returned from the Arctic when editors asked if I wanted to cover the Affordable Care Act during the 2012 election. I didn’t want to do that and said so since I was pretty passionate about environmental issues and few others were covering them. But I said if you let me do a series on pricing and costs and why American medicine costs so much compared to the rest of the world, I’d drop everything to do it.
How does the public tend to look at medical costs?
People tend to look at the price tag for big ticket items such as the half million dollar cancer drug and express amazement; but then they just hope it won’t happen to them. I didn’t want to look at rare medical events but instead at encounters that everyone relates to. I wanted to get people energized to understand the costs and financial incentives. So I focused on ordinary procedures and conditions like colonoscopies, asthma, pregnancy, having a minor skin cancer removed, and getting stitches.
What was the main take-away you wanted for your readers?
I wanted them to understand the incentives that underlie the system and that inflate costs and force us to choose the most expensive way of doing things. I put a lot of thought into those market failures and how we got there. Someone once said we got the system those financial incentives were designed to create. My series started from there.
How did you find patients to profile?
At first I went to NGOs and patient advocates. Everyone had a certain bias and a lot of their files were old and not very useful. So I decided to take another route using reader engagement and social media. To get patients, I did a 400-word story [in February 2013] to say I’m open for business and posted it on the Times’ Well blog. It told of a small study about how hard it was for a patient to get pricing for a hip replacement, and we asked readers if they’d like to share experiences with medical costs. In a few hours we had 500 responses. We didn’t get anyone on the Well blog complaining about colonoscopies, which I wanted to lead off the series, so we put out a tweet on the Times Twitter feed. It was out for 30 seconds and Deirdre Yapalater showed up and eager to describe her $6,385 colonoscopy.
Did you get any patients from the Well blog post?
Yes, I used it to find patients for the piece on hip replacement surgery. That’s how I found Michael Shopenn who turned out to be a great story teller for the piece on why hip replacements cost so much.
When you get lots of responses, how do you choose whose story is best for your piece?
I feel like a movie producer. I would have conversations with prospects since I had their emails. Some people were happy to talk; others weren’t. For this series it was hard work for the patients. They had to show their bills and be willing to have me call their doctors and hospitals, and they had to be willing to be on the front page of The New York Times. Everyone had to be willing to use their full names. The point was to find someone just like other readers who were experiencing the same problems with the cost of a procedure.
Other advice for finding patients?