Bravo for Steve Brill! His appearance on ABC’s This Week was a rare example of a guest on a Sunday news program challenging the prevailing gestalt of the “expert” conversation stream these programs specialize in. It was refreshing to see Brill defend some of the themes in his Bitter Pill magnum opus on healthcare costs, which was recently published in Time (and which I will review shortly). Somehow I never thought of George Will and Steve Rattner as healthcare experts, and viewing this segment did not change that perception. Some highlights from the This Week interview:
On Medicare: Medicare is a big theme in Brill’s 36-pager, so the This Week conversation, which also included Kimberley Strassel, a member of The Wall Street Journal’s editorial board, focused a lot on it. Brill argued on air that Medicare was very efficient. (In fact, as CJR has reported, it controls costs better than the private sector does.)
He argued further that it could control them even better if the handcuffs came off and Medicare was allowed to negotiate the price of drugs, which it is forbidden to do. (That’s the last thing Big Pharma wants.) Medicare “buys healthcare really efficiently, which is a great irony because it’s supposed to be the big government bureaucracy,” Brill told viewers.
Is that true?, the host, George Stephanopoulos, wondered aloud. That was the signal for Rattner to jump in. He conceded that you could “get a fair amount” by negotiating drug prices. But he quickly added that he didn’t want “people to be confused”—negotiating drug prices will not be enough, he argued. His message: What is necessary are “fundamental reforms”—a prettied up phrase meaning large cuts in benefits—would be necessary. He passed along an argument from Medicare “reformers” that is floating around the Beltway—that today’s beneficiaries will get more in benefits than they paid in to the system during their working years. Eugene Steurle, a senior fellow at the Urban Institute, has advanced this value-for-dollar meme, a way of thinking that has often been used as a rationale for the idea of cutting Social Security benefits.
Stephanopoulos didn’t push for more explanation of the value-for-dollar thesis or offer any himself. If he had, viewers might have learned the reason seniors will get so much more in benefits is because of the growth in health spending. (I called Paul Van de Water, a Medicare expert at the Center for Budget and Policy Priorities, who said, “That’s a fact that we have to deal with, but it doesn’t necessarily justify cutting benefits.” And the incredible growth and cost escalation, which results in American healthcare providers being paid many times more than their counterparts in other countries, is the point of Brill’s Time piece.)
Brill pushed back, making the case for lowering—not raising—the age for Medicare eligibility, an idea long since dumped in the dust bin even by its liberal supporters. Brill’s reasoning: “You would put more people in the bucket of much more efficient healthcare,” he said. The president’s plan, Brill went on, will actually raise costs, because people in their early 60s who can’t afford health insurance premiums but must get them now will have to be subsidized by taxpayers—a less efficient mechanism than Medicare.
On making patients healthcare shoppers: Stephanopoulos turned to Will. “George, that becomes an argument for a single-payer system.” Will quickly argued against single-payer. He essentially argued that people are not paying enough for their healthcare, and that somebody else is paying the rest of their bills; that patients, aka consumers, don’t shop around for the lowest priced services the way they shop for cars and toothpaste. (That assumes, of course, that healthcare is a competitive marketplace, a notion that Brill and some health experts have debunked over the years, as CJR has discussed.)
Brill shot back, telling Will: “You’re completely wrong. We have tried that experiment with 30 to 50 million Americans who don’t have health insurance and have to pay 100 percent right now. They have no choice. They are powerless consumers.” When an ER doctor says you need a CT scan, he pointed out, you don’t sit around and wonder if you really need it. Or if this is an efficient emergency room.
Strassel threw in her two cents: A large group of Americans get their healthcare from employers, she said, and they have no “skin-in-the game.” In other words, they need to pay more for their care because if they do, they won’t use as much, and the price will drop. She noted there’s no price transparency, no ability to look around, the way we do when “we spend hours deciding which toaster we’re going to buy,” Strassel said.
Brill countered: “There’s a difference between buying a toaster and buying a CT scan.”