I’m sure a lot of you have Steven Brill’s “America’s Bitter Pill” on your bedside table by now – I’m not going to try to recap it here.
But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform.
- Here’s a Sunday New York Times book review by Zephyr Teachout.
- Here’s Malcolm Gladwell in the New Yorker.
- And Peter Orszag (who was in the Obama administration when the bill was being written and appears in the book) at Bloomberg View writes about what he thinks Brill got wrong.
- Avik Roy at Forbes has a conservative perspective.
The second book (and I should say that while I have a copy, I loaned it to a colleague before I read it myself…) is by the Washington Examiner‘s commentary editor, Philip Klein, who looks at the options and thoughts on the right in “Overcoming Obamacare: Three Approaches to Reversing The Government Takeover of Health Care.” It hasn’t been as widely reviewed as Brill’s book but Aaron Carroll gives it an interesting write-up in the Incidental Economist blog.
Critics on the left?
Critics on the left? That’s not any “left” that I can recognize. The left that I grew up with now believes in adopting the systems that work well in the European social democracies, like the Scandinavian countries, as Bernie Sanders put it. In health care, Marcia Angell and a lot of other respectable doctors favor single payer — since it’s working in Canada. The left means single payer. At least give a book review that mentions single payer:
Steven Brill’s ‘America’s Bitter Pill’ tackles healthcare mess
By Zach Dorfman
Los Angeles Times
January 15, 2015
In the book’s final section, Brill appends some inventive if not entirely convincing proposals for decreasing long-term costs and improving care. Though far from an ideologue — he has a businessman’s pragmatism — he gives short shrift to proponents of a “Medicare-for-all” or single-payer option, failing to seriously analyze, or really analyze at all, the financial or social benefits of such a system. (The United Kingdom, that fearful bastion of socialized medicine, spends roughly 9% of its GDP on healthcare; in the United States the figure is close to 18%.)
I can’t find reviews of “America’s Bitter Pill” from anyone on the left, but there are plenty of good critics on the left of Brill’s ideas, based on his Time article:
Obamacare: How It Should Be Fixed
New York Review of Books
August 15, 2013
Bitter Pill: Why Medical Bills Are Killing Us
a special report by Steven Brill
Time, March 4, 2013
However, more than a few liberals think the ACA … will ultimately fail because it does not basically change our dysfunctional system. It expands and improves private insurance coverage, but provides no effective controls of rising costs and no significant change in the way medical care is delivered. Many of the critics think we need major reform that replaces private insurance and employment-based coverage with a publicly funded single-payer system.
Unfortunately, [Brill’s] measures only address the margins of the cost problem. They … do not address the underlying causes of the health cost explosion, namely a private insurance system and a fragmented, income-seeking medical care delivery system that is largely paid by fee-for-service. Brill concludes that medical prices are much too high, but he never tells us why.
Steven Brill’s Opus on Health Care
By Matthew Yglesias
Feb. 22, 2013
(Steven Brill’s cover story on hospital pricing is wrong. Who pays determines how high the price is. An individual patient is subject to price gouging. A key service of an insurance company is bargaining with hospitals so you pay less. The best bargainer of all is Medicare. Two conclusions, which Brill ignores, is that Medicare should cover everyone, and that we should adopt price controls, as Singapore does.)
“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.”