Skip to main content

Kudos to Time Magazine and Stephen Brill who present this week a great comprehensive article about the flaws in our healthcare system:

Bitter Pill: Why Medical Bills Are Killing Us

(I thought Time Magazine content was behind a paywall, but I was able to access the article. Perhpas it is available for a limited time and disappears when it becomes an archive? Not sure. But do yourself a favor and head right over to the link above and read the article)

Find out how LOWERING the age of Medicare as opposed to the common wisdom of raising the age of Medicare will lower the arc of healthcare costs overall.

Brill points out how Medicare could be even MORE efficient if some of the self-imposed handcuffs Congress has placed on it due to the interference of lobbyists and self-interests were removed - like negotiating the costs of drugs (duh!)

He also discusses the inherent inequalities in our system - showing how exactly the same operation has varying costs depending on who is paying the bill.

Brill has been making the rounds of the talking head shows and it's lots of fun watching balloon heads like George Will's explode when presented with the facts about our healthcare system. This just happened on Stephanopoulis. Imagine a journalist from a mainstream media magazine going around and pointing out that fiscal prudence and savings are achieved by EXPANDING the safety net as opposed to cutting it!

The article and Brill also point out that Obama care does not re mediate or cure  the underlying issues behind sky-rocketing health care costs.

A hundred diaries could be written using this article as a jumping off point. All I can say, is read it and send it along to everyone you can think of and lets start immediate improvement and expansion of the doors Obamacare opened -

1st order of business is opening up Medicare as the Public Option to anyone not covered by an employer policy, regardless of age. 2nd Order of business is allowing Medicare to negotiate drug costs as the other government health programs like Medicaid and the VA do.

And again, thank you to Stephen Brill for his work in publicizing widely what so many of us already know, but which has been confined primarily to the bloggosphere. He has provided a very powerful article to deploy in our battle for affordable and accessible healthcare for each and every American.

EMAIL TO A FRIEND X
Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags

?

More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  Thanks, will read it (6+ / 0-)

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sun Feb 24, 2013 at 08:33:10 AM PST

  •  This is Why During the 08 Campaign I Suggested (13+ / 0-)

    to the Obama team "Medicare for Microbusiness" meaning self employed individuals.

    First it was a job creation policy because it would encourage millions of people who moonlight with their skills to leave full-time employment, thereby opening up jobs, second it would make small businesses jealous for Medicare to relieve them of their health care costs, and on to create a cascade where the private sector would increasingly demand the relief of single payer.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Feb 24, 2013 at 08:43:31 AM PST

  •  Same with Social Security... (8+ / 0-)

    LOWER the eligibility age and more folks will retire, opening jobs up for younger folks.

    Isn’t it ironic to think that man might determine his own future by something so seemingly trivial as the choice of an insect spray. ~ Rachel Carson, Silent Spring ~

    by MA Liberal on Sun Feb 24, 2013 at 08:48:19 AM PST

  •  I think it's great that Brill is highlighting (6+ / 0-)

    the conflicts of interest our medical system has created, but I'm going to ding him on one issue - focusing on the marginal cost to producing a dose of a drug like Rituxan as opposed to the total cost of making that drug.

    the incremental expense of producing and shipping each of its products compared with what it sells them for — was only 10%. That’s lower than the incremental cost of sales for most software companies, and the software companies usually don’t produce anything physical or have to pay to ship anything.
    The costs involved in making a drug are mostly incurred well before the first dose is sold.

    First up, drug companies now spend four billion dollars on average in R and D per new drug. That's not a made up figure, it's calculated from what publicly traded companies are required to disclose. It's also not a padded number: stockholders hate to see money disappear into the black hole that is pharma R & D, not to be seen again for 5 or 10 years, if ever. If anything, Pharmas have an incentive to hide their R&D spending in other places, not pad it.

    Secondly plants that create drugs like Rituxan typically cost hundreds of millions of dollars to establish and license, something that doesn't figure into marginal costs.

    Making one additional dose might cost $300, but the first dose cost $4 billion and change.

    •  I understand your point (12+ / 0-)

      But, even with the expense of R&D, the drug companies are making billions and billions.

      Plus, I have read that much R&D is done with government grant money in public universities and even so, the patents go to the drug companies. I have also read that drug companies spend more on marketing than R&D.

      Plus, no one understands why Americans seem to bear the burden of the R&D and drug development alone as other countries negotiate the drug prices while we are simply gouged because that is what our system allows.

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Sun Feb 24, 2013 at 09:05:47 AM PST

      [ Parent ]

      •  The spending on drug development is (0+ / 0-)

        tricky to untangle.
        The academic part of drug development is almost all basic research: identifying potential drug targets. It's not cheap, but doesn't in itself find new drugs. Some academic labs do invent new drugs, but year in, year out, about 80% of them are invented by industry.

        When universities do invent new drugs, they patent and license those inventions (and sue the bejeezus out of infringers) just like the companies do.

        The part where universities lose out is when a professor comes up with the general idea while at a university but forms a biotech and develops the actual patented drug there. How much the university gets depends on the contract they had the professor sign.

        Pharmas spend more on marketing than on R&D these days. That doesn't drive up the cost per dose though - it drives up the number of doses sold. The price per dose for a drug under patent is always easily calculated: solve for the maximum value of: (price this customer is willing to pay) x (amount they will buy at that price). Repeat every damn day with every damn customer til the patentexpires.  Overall irresponsible marketing drives up costs to our country through unnecessary to unconscionable prescriptions though.

        The $4 billion figure doesn't include marketing, just R&D costs.

    •  As the article asks: (1+ / 0-)
      Recommended by:
      Creosote

      Given that people in other countries pay half as much as we do for these drugs, who decided that sick Americans must bear the whole burden of discovery and development? When did we sign up for that?

      What is valued is practiced. What is not valued is not practiced. -- Plato

      by RobLewis on Sun Feb 24, 2013 at 06:25:41 PM PST

      [ Parent ]

  •  this article has been getting a lot of attention (6+ / 0-)

    this week. not really sure why as everyone knows medical costs are prohibitive and thousands  upon thousands of articles about it have already been written. what part of this are people shocked by?

    i happened to catch Brill and Will and the rest of the pundits on ABC this morning - this 'conversation' (other than Brill's info of course) is so repetitive and based on privileged assumptions, the one woman saying 'very few people' are in the class with no insurance and thus affected, and Will for the millionth time saying how medicine isn't subject to forces of consumerism, no one asks 'how much will that cost' in the doctor's office and people just consume and consume healthcare because they don't pay for it. Maybe 1% with gold plated insurance, but no one else, not even people who are insured - like the couple in the story - as if insurance just pays for everything without question. Such nonsense!!!!! What's even the point of such a conversation?

    "I'm sculpting now. Landscapes mostly." ~ Yogi Bear

    by eXtina on Sun Feb 24, 2013 at 08:53:48 AM PST

    •  Actually, a shocking number of people DON'T know (7+ / 0-)

      why healthcare costs are so high and as long as they themselves are covered they will accept the premises of the idiot espousing that "very few" people are uncovered, and that the only thing wrong with our system is "government bureaucrats" getting in the way of the free market.

      It is incredibly refreshing to see a large mainstream media publication take head-on a lot of the mythology about our healthcare system. That's why it's a big deal.

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Sun Feb 24, 2013 at 09:12:12 AM PST

      [ Parent ]

  •  The article is outstanding (12+ / 0-)

    It gets you enraged about the injustice and the greed that fuels it, and takes it to another level when you realize it's destroying our economy too. You hear the feeble protests of bought and paid for politicians who say its impossible to reduce costs, then look at every other developed nation in the world doing that every single day.

    Congress is swimming in corruption, the medical industry is riding the gravy train, and our leaders have the gall to say we have to cut benefits for the sick and injured to pay for it.

  •  There was an incisive piece by Yglesias on Brill's (4+ / 0-)
    Recommended by:
    GayHillbilly, splashoil, ferg, elwior

    piece - which he wrote on Slate's site.

    Not so much damning with faint praise as praising then showing a damnable flaw in analysis.

    Steven Brill's cover story in Time on hospital pricing is quite brilliant, but also extremely long.
    :: ::

    The framing device, which is clever but wrong, says we spend too much time debating who should pay for U.S. health care and not enough time debating why the prices are so high.

    Where Yglesias fins fault is in where Brill's correctly reported litany of price-gouging should lead.
    I can see two reasonable policy conclusions to draw from this, neither of which Brill embraces.
    These prescriptions are, no surprise really,

    -- Medicare for all (NHS, Canadian system) - and, or

    -- True price controls, everywhere (the German / Singapore system)

    He has another piece, referencing Brill, which he printed at his Moneybox column on Slate just this Friday which goes to how health care providers fare with Medicare under the present system. It asks whether they do, as often claimed, lose money under the present system.

    His answer is that yes, they can, as long as their model demands continued construction of high capital cost institutions - supportable only by high rates of revenue.

    •  did you actually read the Brill article? (1+ / 0-)
      Recommended by:
      Creosote

      because if you did you would know he calls out big medical business for high profit margins and high CEO pay.  He also calls them out for fraudulent double or triple billing and ripping off private payers.

      •  I did - but, here's Yglesias' primary conclusion (2+ / 0-)
        Recommended by:
        wilderness voice, T Maysle

        vis-a-vis Brill - who, you should note Yglesias did say wrote a good aricle - but with odd conclusions:

        For reasons I do not understand after having read the conclusion twice, Brill rejects both of these ideas (Medicare for all, true price controls) 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.
        His two suggested alternatives (vide supra) are more forceful, and far more effective than Brill's.
  •  ACA won't cut it. (3+ / 0-)
    Recommended by:
    elwior, footNmouth, Ramoth

    There has been lots of fluff here at Kos about all the wonderful exchanges and all.  At the end of the day you are still at the mercy of these predators described by Brill.  That is why we need single payer.  Obama and his shills have tilted the table so much it just seems hopeless.  Most here just prefer to ignore this.  What a cruel joke on us all.

    •  Again, that is why this is an mportant article (4+ / 0-)
      Recommended by:
      T Maysle, kareylou, splashoil, Creosote

      The ACA simply changes WHO is paying but not WHAT they are paying, particularly with the same for-profit companies still being the major providers without serious competition from anyone, like an actual public option and/or Medicare to actually reign in costs.

      I LOVE that Brill says the way to save money is by enlarging the system as opposed to contracting it - I've seen him say that on at least 3 talk shows now and the idiot pundits have no answer and are rendered speechless and sputtering.

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Sun Feb 24, 2013 at 12:20:50 PM PST

      [ Parent ]

      •  The ACA type of "expansion" (0+ / 0-)

        Just brings in more victims.  Medicaid expansion sounds great until Obama allows predators like Scott in Florida to privatize it.  Just think:  what could possibly go wrong with that?  Then there is the usually ignored clawback of the "free health care" costs by the States mandated by the Fed's.  No one ever talks about that.  Most think it is just limited to NH care.
        Brill stops short of seeing the answer is single payer or Medicare for all.  Is it just too obvious to see?
        Thank you for keeping this article in view.  It's only a few "usual suspects" here at Kos who dare to bring in the whole story and ignore the fluff propaganda.
        Shame

        Our problem is not a matter of shitty policy arrangements. We have plenty of those. Whatever. Policy is a third-order pile of bullshit. Our problem is that it is a sick excuse for a society when this sort of ass-rape is relegated by custom and practice into the sphere of the “private”, the sort of bureaucratic struggle one quietly hires professionals to deal with and hides as much as possible from friends and coworkers. Ass-rape of the more literal sort is also a private affair, in the first order. We insist upon it being public, because a society whose customs tolerated the maintenance of its first-order privacy would be a miserable, detestable place in which the powerful quietly ass-raped the powerless and were never held to account. The difference between literal ass-rape and what happened to Alice and Steven D. is not that ass-rape is criminal while health-care price-gouging, although regrettable, is not. To say that is to confuse cause for effect. Literal ass-rape is criminal because we-the-people as a broad-based mass are disgusted by it and insist upon it being a public and criminal matter rather than a quiet tragedy and struggle. When we hear about a Joe Paterno who overlooks this requirement, we literally hound the motherfucker to death. Perhaps unfairly, in any particular case — pitchforks are simultaneously sharp and blunt instruments! The sheer fear of which is why the powerful create laws. But where laws aren’t there, the pitchforks must always be. A society that expects laws to substitute for, rather than channel, public outrage, is a society not long for this world in any form worthy of the name. Outrage and shame are primary.

        As soon as you delve into the policy wonkery in cases like this, you are submitting to a conspiracy by the powerful against the many. The greater the sphere of disagreeable things that are “complicated”, the more it is possible to construct intricate and inscrutable bureaucracies to “arbitrate”. There will be think-tanks and policy papers, funded by people who are well-meaning (in a narrow, idiotically un-self-aware way) but very rich and powerful. The conclusions of which will be earnest and carefully researched but confined to a window not very upsetting to the very rich and powerful. Undoing the ability of plutocrat hospital “CEOs”, or bankers or lobbyists or whatever, to continue the sort of ass-rape to which their lifestyles have grown accustomed will not be on the table. A good society depends on an active public, first and foremost. A society that has allowed the predations of the powerful to become purely private matters mediated via “markets”, courts, academies, and bureaucracies, that has delegated “activism” to a mostly protected professional class, is nothing more than a herd hoping that today it is somebody else who will be slaughtered.

        Is that who we are?

        Steven Brill's Opus
        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.
        The ACA may be poisoned the well for constructive change to overturn the rentiers and predators.  I hear my friends tell me it will lead to single payer. but I wonder if we will ever be able to grab the ball again...
        •  Just an Update re: Medicaid Expansion/Privatizing (0+ / 0-)

          Others have started looking at what is going on.  It's another bipartisan thing!  Privatization has already got the nod from Obama in several States.  Medical loss ratios don't seem to be required in this new growth opportunity for the rentiers and predators.  There is a good post and comment thread over at FDL.   What a surprise the emerging picture is not pretty if you are concerned about cost control and abuse.

          •  Privatization of Medicaid (0+ / 0-)

            Capitulation or Manipulation?

            But not so noticed are the conditions Scott was able to extract: his agreement is only for the first three years when the federal budget will pick up 100% of the cost, and, especially, all of these federal dollars will be privatized, pending, as HuffPo is careful to point out, approval by the Centers for Medicare and Medicaid Services. (Scott says his decision is made regardless of theirs, but I imagine he only says that because he’s confident they’ll approve the deal)

            In the second most high-profile of these reversals, Arizona Governor Jan Brewer agreed in January to join the expansion, saying that the Affordable Care Act was the law of the land, like it or not. However, her acceptance was conditional in that, as a “circuit breaker,” Arizona will reduce the extra Medicaid enrollment the Act allows in proportion to reduction in the federal subsidy. This is the way to “keep Arizona tax dollars in Arizona,” as the Governor’s official website crows. Moreover, the program will be managed within a regime called the Arizona Health Care Cost Containment System, which appears Byzantine in complexity but, as the bottom line, entails entirely privatized care.

            This is something that will be "bipartisan" and ugly.
  •  Two numbers to remember (1+ / 0-)
    Recommended by:
    WakeUpNeo

    from the article:

    1. Average cost to process a Social Security claim: $3.80, or 2/3 of 1% of the amount paid out.

    2. Average cost to process a private insurer (Aetna) claim: $30, or 29% of the amount paid out.

    Free market!

    (And more than 90% of the people processing Social Security claims work for private contractors.)

    This is absolutely must-read-and-forward.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Sun Feb 24, 2013 at 06:22:44 PM PST

  •  Steven Brill ROCKS (1+ / 0-)
    Recommended by:
    WakeUpNeo

    1 awesome Dude

    Who is mighty ? One who turns an enemy into a friend !

    by OMwordTHRUdaFOG on Sun Feb 24, 2013 at 06:24:52 PM PST

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site