How Not to Fix Health Care: Steven Brill’s Time Magazine Piece

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Steven Brill, the author of the well-known Time piece “America’s Bitter Pill” (now a book), recently published something of a follow-up story in the magazine called “What I Learned from My $190,000 Surgery.” Aside from a title indicative of a print world attempting desperately to stay relevant in an increasingly digital, clickbait-ridden universe, it’s not a terribly written article. If I were still teaching comp-lit to freshmen, I’d point out the mish-mash of ethos and pathos in that title as well, as if simply receiving a surgery approaching a quarter million dollars confers some type of authority, and how we’re supposed to empathize with this journey of Brill’s as it becomes clear that this shocking sum of money is something each of us could easily fall under the aegis of in the current medical therapeutics landscape. But cheap tricks aside, it’s generally readable and full of some useful statistics, like the astonishing sum the U.S. spends on healthcare each year—$3 trillion.

And yet, at the end of this piece which employs the age-old rhetorical trick of calling something broken and suggesting the best way to fix it is, inconceivably (at first…), to let events run their course, I found myself just mostly disappointed. Dramatic fixes to the desperate problems of health care in America are a dime a dozen these days, and this essay—despite my hopes—offers nothing really very new.

Brill’s argument, seemingly one the reader should intimate during the course of the piece is that those we look up to to fix these fragile meat-sacks we call bodies (doctors) are also in some places increasingly those we have been conditioned to loathe in this “capitalist” world (health insurers, and large corporations, and the avaricious), and rather than a harbinger of the coming Armageddon this is in fact A Good Thing. These doctor-entrepreneurs, the author suggests, who (the historically uninformed among us assume) revolutionarily step across the traditional divide between treating disease and paying for that treatment, are not in fact indicative of a system in deterioration, but rather in rebirth. We only need to help it along. In this way we can cut costs while simultaneously ensuring an excellent standard of care in our clinics, hospitals, and emergency rooms. By letting hospitals offer insurance, he declares, we cut out a middleman who remains at a distance from the act of medicine as it takes place. Doctors would no longer inflate the costs of the medical care they provide, because they’re the ones paying for it. Seems commonsensical, right?

And yet, like so many other simple solutions to complex answers, Brill’s falls apart once it’s removed from the neat and uncomplicated place where thought experiments are conducted.

Brill assures us his solution would elegantly solve many of our current woes, and yet from the outset I’m suspicious of anyone who looks at a bad situation getting worse and suggests that the best solution is to lean into it. He does nothing to allay those anxieties.

The piece is remarkably absent of any sense of how, for instance, medical care costs for regular people have fallen in the area served by the University of Pittsburgh Medical Center—one of these revolutionary new systems headed by Jeffrey Romoff, who’s managed to buy up a significant percentage of doctor’s practices, clinics, and hospitals in the region and extend his hospital’s health insurance division’s market share at the expense of traditional insurance.

It treats not at all geographic disparities in both income and quality of care in the United States—one of, in my eyes, the single things nationally penetrating insurance companies can offset to some degree by shifting costs from those who can’t afford to pay to those who can, and offering networks of knowledge and expertise so that patients can go to where the best treatment is.

Brill assures us competition, that magical force of the free market, would ensure the best medicine at the best price. How? Regulation, of course, that magical, opposite force of the social welfare state! Contradictory? Not necessarily, but I’ve never met a federal regulatory agency doing its job well, so it’s an uphill case to be made for that being the sole line of defense between us and them.

Similarly confounding is Brill’s argument that at least two of these entities in a given market would prevent monopolistic practices, with naught to help but a little government oversight. Right. In an industry worth $3 trillion. By comparison, the cable industry (Comcast-TWC-etc) is maybe a tenth as big, and we all know the FCC and Congress do an excellent job of keeping things equitable, consumer-friendly, and above-board.

I have no solutions here, but I do have a suggestion: let’s stop pretending health care is something that can be fixed with simple economics. Health and wellness are schemas that are way too complicated to be quantified that easily, and echo across all the registers of a modern society. They’re ineluctably rooted in what we imagine good health to be, as well as what it’s not. Their theorization, definition, and enactment necessitate acknowledging all of the multifarious economic, cultural, social, and psychological forces of three hundred million people who don’t want to be sick at the lowest possible cost but then will spend anything to stave off death for a few more days, weeks, months, and years. If we stop pretending the solution can neglect all these things, maybe we can get somewhere.

 

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