Town Square

Brill’s Pill, Distilled

Original post made by Tom Cushing, Danville, on Mar 15, 2013

I’ve admired Steven Brill since our much shaggier days; his early, spot-on exposee of the Teamsters was an act of journalistic courage. He has recently faced an even more formidable foe in the American health care system, of which he has written a 25,000 word diagnosis in Time magazine (“Bitter Pill”, March 4 issue). Instead of the current political warfare over Who pays our medical bills, he asserts, we should instead be asking “WHY are these bills So Dam’ High?”

This story contains 795 words.

If you are a paid subscriber, check to make sure you have logged in. Otherwise our system cannot recognize you as having full free access to our site.

If you are a paid print subscriber and haven't yet set up an online account, click here to get your online account activated.


Like this comment
Posted by Jack Sparrow
a resident of Diablo
on Mar 20, 2013 at 2:43 pm

My goodness---admitting Obamakill will make premiums rise?? This will....and not for a "temporary" time. Will denial of service (let them die) be race related so as to kill off Caucasians faster? Teddy Kennedy's 1965 immigration reform not destroying the USA fast enough? Probably. We are the brave new world.....thanks socialists.

Like this comment
Posted by cardinal
a resident of Diablo
on Mar 20, 2013 at 4:59 pm

Arrrrr, Cap'n Jack Sparrow: I tried translatin' yer comment from th' buccanneer dialect into English, but 't didna help. Ye be lily livered that Obama wants t' kill white folks, but he`s half white, so wouldna he want t' only kill half o' them? An' what does Teddy Kennedy be havin' t' do wi' anythin'? We know he wasn`t much o' a seafarin` man.

Anyway, th' parrot an' I agrees that ye be one strange bird.

Troth tol', yar a scallywag who ortin' t' be keel hauled!

Like this comment
Posted by Tom Cushing
a resident of Alamo
on Mar 21, 2013 at 6:14 am

Jack: I don't know Brill's politics, so I'm not sure I'd call his prediction about future premiums an 'admission.' I do think he's right that the new approach has not been designed to address the system flaws he describes in this article.

The article, though, is about Those flaws. Do you have any ideas about That subject, lest folks are left to suspect that the parrot and the red head are correct (matey)?

Like this comment
Posted by C. R. Mudgeon
a resident of Danville
on Mar 26, 2013 at 2:42 pm

In the end, the fundamental problem is essentially one of cost-shifting, which serves to blunt or even eliminate any beneficial effects of competition.

Brill somewhat acknowledges this, I think, in saying that the insurance companies are not really the main problem here. Indeed, there is a reasonably competitive and some-what efficient "marketplace" for health insurance. Companies are very able to shop around for better rates for their employee health plans, and even individuals have some degree of ability to shop for different levels of coverage, from different vendors.

But this all breaks down at the service-provider level. No one really shops for better hospital rates, nor ER rates, nor regular doctor rates. And while the insurance companies DO have some leverage with hospitals and other service providers, it is limited by geography. The inurance companies want to have broad inclusion of service providers so that the shoppers of insurance plans will see that their local providers are covered by the plan. So this takes away the main insurance company leverage - which is dropping a provider from coverage. It's relatively easy to drop a doctor, or even a local medical group. But not easy at all for an insurance company to just drop a hospital (at least not without ticking off lots of their plan participants.

I'm very leery of government-run single-payer proposals. That said, an argument might be made that a single-payer system that only extends to the hospitalization part of an insurance plan, and perhaps just for "catestrophic" coverage, might make sense. You could still have the actual doctors bills and specialists bills be borne by regular insurance, since there are enough choices so that the insurance companies could actually drop doctors or surgeons who charged too much. This sort of "hybrid" private/public health insurance might well get rid of the most un-competitive situations (by putting them under regulation), while letting competitive forces work where they have a chance of working. Just my $0.02.

I agree that Obama-care doesn't address this issue. However, one might argue that Obama-care was actually designed/intended to raise health insurance rates, so as to drive people toward a single-payer system over time. That's not part of the talking points, of course. But it seems like that's what the impact will be....

Like this comment
Posted by Tom Cushing
a resident of Alamo
on Mar 28, 2013 at 5:17 pm

CRM: Yup -- I agree with your characterization of the market failure. It's a little like a public-type utility, in that everybody needs it, and yet you cannot shop for it -- like a utility, except that it is completely unregulated as to price. Imagine what PG&E could do with that kind of freedom!

I've had both hips replaced, grace of my misspent youth. Surgeon who did hip 1 had moved to Austin; I was so happy with the result that I tried to comparison-shop to get hip 2 done there. Couldn't do it, even with his help. His former partner did hip 2 here, and I'm as happy with that job, but I learned that you cannot be an informed consumer -- even on non-emergency service that you can schedule ahead.

I also like your half/half idea, except there may be too many moving parts at that point. I doubt ObamaCare was passed for the purpose of eventually reaching single payor -- but that said, I'm guessing that's where we're headed. Maybe Hillary will get us there, after all? (I know you'll love That idea.)