Friday, September 04, 2015

"America's Bitter Pill" could help cure our overpriced health care

My companion on a daylong train ride was Steven Brill's recent book about the difficult passage and nearly disastrous implementation of the Affordable Care Act.  The book is Bitter Pill: Money,
Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.  It's a riveting saga.  I didn't want to put it down.  Anybody who likes politics, cares about public policy in general, or wants to know why hospitals overcharge for the simplest care would do well to grab this book and give it a few nights of close attention.  It's freshly out in paperback, your good fortune.

Brill is a masterful reporter and a no-frills writer.  He aims for clarity and comprehension rather than rhetorical thunder.  I thank him for that, because the birthing of the Affordable Care Act (think Obamacare) by a sometimes reluctant Congress was seriously complicated.  It also barely resembled the inspirational process we were taught from the 3rd Grade on.

If you hoped for a healthcare revolution from Obamacare, this book will let you down easy. Though millions of Americans now can obtain treatment and preventive care that two years ago was beyond their reach, there'll be no revolution.  Why there will not is explained in the hard choices made in Congress and the White House under the cold-eyed opposition of the Republican Party and the incessant pressure of the well-funded insurance industry and the makers of medical devices and prescription medicines.  Doctors and hospitals, through their lobbyists and publicity campaigns, also had a hand in making the healthcare reform less than it ought to have been.  And yet, a handful of hospitals, run by physician executives, and one new insurance company, are held up by Brill as  examples for further reform that could build on what the ACA has begun -- for the benefit of us all.

Brill concludes with a 50-page pragmatic prescription for how to continue the reform that presidents as far back as Theodore Roosevelt proposed or attempted but only Lyndon Johnson and now Barack Obama achieved.  This chapter is anything but rosy-eyed, but if you've read the chapters before you'll know how much human suffering can be avoided, and what destabilizing cost to the economy, if we persevere as President Obama did. 

(Footnote: One remedy that Brill recommends is to limit the government-protected monopoly on new drugs that assures their makers huge profits for years and years. This week, Sen. Bernie Sanders fleshed out that idea by proposing to let Medicare negotiate drug prices as is done in Canada and other countries with admirable and less-costly health care. For more about that, see Think Progress.)