America's Bitter Pill: Healthcare System Reform - Money, Politics & Backroom Deals in US Healthcare Crisis | Political Books, Healthcare Policy Analysis, American Reform History | Perfect for Policy Makers, Students & Political Enthusiasts

I’m wary of hyperboles and blanket statements. Having said that, every American should read this book.There’s an old saying about Washington—the shocking thing isn’t how much lawbreaking goes on, the shocking thing is what’s legal. And what this book depicts, beyond just a messy fight to bring some fairness to a bloated and corrupt system, is the dysfunction at the heart of American politics. We freely criticize politicians, but this book makes it all too clear that they’re not in charge—the money is. Every industry or interest group that turns a decent profit has lobbyists in place to flatten any piece of legislation that threatens to derail their gravy train. Republican or Democrat, it doesn’t matter—your campaign contributions will rise or fall based on what you support or oppose. So unless you’re in a completely safe seat ideologically—the reddest of the red, or the bluest of the blue—you will need to pay attention to the lobbyists.Since our healthcare industry comprises one sixth of the richest economy in the world, it should be no surprise that it has some tremendously effective lobbyists. Thus the problems with Obamacare are the same as the problems with George W. Bush’s prescription drug benefits for seniors: while both are ostensibly aimed at alleviating the financial medical pain of the American consumer, neither made a serious effort to reign in the primary source of that pain. And as Brill’s book makes clear, the source of that pain, oddly enough, isn’t so much the insurance companies that are squeezing us for larger and larger premiums every year—it’s the pharmaceutical companies and medical device manufacturers that are squeezing the insurance companies. (Not that the insurance companies aren’t turning a profit, but as Brill makes clear, they, too, are consumers, paying prices that are suspiciously arbitrary and even, like the $1000-per-pill cost of Sovaldi.) (A quick aside: conservatives are quick to point out that you have to pay for other things that keep you alive, like food, so why not healthcare, too? But it’s a flawed analogy. Food is an industry with a tremendous range of options, and low barriers to entry, so it’s very easy for new providers to enter the market at a low price point. And no one meal keeps you alive, so skimping or splurging here and there doesn’t make much of a difference. So the free market works far more efficiently for food than it does for medicine—there are innumerable ways to feed a hunger, but far fewer ways to clear a blocked artery or treat hepatitis C.)Granted, nobody ever thinks they’re the bogeyman. So, too, in healthcare. The pharmaceutical industry’s lobby, led by former Republican congressman Billy Tauzin, is convinced that they are the world’s engine of medical innovation; they’re clearly entranced by the righteousness of the cause that’s earning them so much money. (Tauzin even has his own wonderful I-beat-cancer-thanks-to-big-Pharma story, pretty much the medical equivalent of “Not only am I president of the Hair Club For Men, I’m also a satisfied member.”) But the great strength of this book is Brill’s ability to get behind everyone’s story and crunch the real numbers—he looks at Amgen’s financials for 2013, for instance, which seem to show that the company’s advertising and marketing expenses are substantially higher than its research and development costs, or its production costs.It’s understandable, to some extent—having been in business myself, I know that you can make the greatest product in the world, but if nobody knows about it, it’ll never sell. But our situation in the U.S. is different from Canada and Europe, in that drug makers can market these products directly to patients (who can then ask doctors if such-and-such a pill is right for them) rather than only advertising to doctors, who might be slightly more knowledgeable about the effectiveness of said pill. As the book makes clear, the industry very effectively fought to water down a provision in Obamacare to measure the effectiveness of various drugs and treatments and pay accordingly. (The pharmaceutical industry has also legally protected its prices with its largest consumer, Medicare. Rather than, say, using its power as a consumer to negotiate lower rates, the way Wal-Mart or Amazon might do with its suppliers, Brill tells how the government is legally handcuffed to an arbitrary percentage [106%] of the fair-market-value for a given drug—a value that has little clear relation to what it costs the drug companies to produce and sell the drug, and no clear relation to its effectiveness relative to other drugs.) So you have a well-entrenched lobby for a group that performs a valuable service resisting any efforts at accountability for how well they provide that service—it’s like a teacher’s union on steroids.This is not to say that corporations are villians, or that government is blameless and noble in all of this. Indeed, as Brill makes clear, there have been problems all around, both in the status quo ante-Obamacare, and in the Obama administration’s flawed implementation of a flawed law, and in the relentlessly ideological opposition to that law. One salient point Brill makes: Obama’s team made much the same decision when implementing Obamacare that Romney’s team made when implementing Romneycare—to work on universal coverage first, rather than tackling costs. (Politics, they say, is the art of the possible, and nobody apparently believes it’s even possible to rein in the pharmaceutical industry.) He also rightly calls the Obama administration out for slow-pedaling the implementation of its own signature law, especially in the run-up to the 2012 election—delays which seem like they were mostly motivated by fear. And he does a great job of sorting through the chaotic launch of the Healthcare.gov website, sorting through the tangled org charts and email chains that led to the well-publicized botched launch. (Having been part of a botched website launch in the private sector, I can assure you that the government has no monopoly on incompetence in such matters.) Even given that it was a government project, it didn’t need to be that way; along the way, he helpfully contrasts the initial Healthcare.gov efforts with the smooth and efficient launch of Kentucky’s Obamacare website, and he shows, too, how the ferocious efforts of a tiger team of industry veterans eventually brought order out of chaos on the federal site.There are a few quibbles with the book: Brill ends up spending a decent amount of time writing his own prescriptions, althought it might have been worthwhile to simply have a thorough diagnosis instead. And while he does make clear how reluctant the Democrats are to take on their own pet lobbies, such as the trial lawyers, it’s tough to tell how much they’re to blame for out-of-control-costs, relative to Big Pharma and the others. Lastly, it’s difficult to keep some of the names and personalities straight, particularly when he’s discussing the Healthcare.gov launch. (In fairness to Brill, it was a very confusing project initially; everyone was responsible, so no one was. And he does a great job with some of the more outsized personalities, thanks in part to having the journalist’s ear for the telling quote, the one that captures a personality and a worldview. [In discussing Billy Tauzin’s desire to be involved in meetings where large decisions were being made, for instance, he cites one of the former congressman’s favorite dictums: “If you’re not at the table, you’re on the menu.” It’s an earthy and endearing maxim, one that humanizes a man who could just as easily be demonized.])Still, Brill’s performed a valuable public service in sorting through this tangled mess. And rather than discussing all of it from an icy journalistic distance, Brill adds some worthwhile personal discussions while mentioning a health problem of his own, an aortic anyeurism which hospitalized him and forced him to undergo possibly life-saving surgery.And here Brill gets at why it’s really so profoundly difficult to fix our health care. Our bodies are as flawed as any physical object, and all are doomed to break eventually, but nobody wants to skimp on fixes when it’s their health at stake. (As he puts it, nobody wants to do a cost-benefit analysis on their own health—they just want to maximize the benefit.) So in a sense, WE are to blame, as much as any industry or group of lobbyists. We are the ones who fall prey to the incessant marketing from hospitals and insurers and makers of little purple pills; we are the ones staring at ad after ad for Prilosec and Levitra, and then wondering why our insurance costs are so high. We are the ones less concerned with diet and exercise, and more concerned with paying someone else to fix us. America, heal thyself.I liked the time life article he wrote called Bitter Pill alot better than the book. I dont care for the blame game that the book looks into.Long story short, went to the er out of pain and fear that my appendix may burst and cause death. Quick money saving lessons learned at my BIG expense. Lesson 1. Don't look up your symptoms on the internet and don't trust Web Md or any internet medical advice because at best they err on the side of caution thanks to lawyers and at worst they direct people to the hospital money machine. Internet medical site made me think I was having an appendix problem and also said not to take a antacid which can make it worse. Lesson 2. Have strong prescription pain medication available to manage late night weekend pain to allow non hospital doctor visit. Having a loved one crying in pain and waiting hours or days till regular doctor office is open will be tough for a person to do, so its the ER or wait. Lesson 3. Try over the counter heartburn medication to see if it stops the pain your having because you don't want to go to a regular doctor clinic only for them to tell you to take over the counter pain medication which you could've done before spending the money and time going to the doctor. I didn't have any heart burn burning sensation at all, instead my stomach felt like I was punched in the gut, sometimes the pain would radiate to my kidneys and lower back. In fact from my research there have been people who went to the ER thinking they were having a heart attack only to be told it was heartburn. So I'm taking an heartburn medication for any internal pain in by abdominal area. So I go with no health insurance to the hospital er, yea I knew it would be more expensive than a regular doctor visit but as I said I was in pain and was thinking my appendix was going to burst and die thanks to Web Md. Before any test were donte my nurse practitoner told me that it was not my appendex because of the location of my pain so I was thankful for that. So I have blood work done, IV bag given to me, Sonogram, and CT scan with contrast. At the time I even questioned if the CT scan was necessary because they mentioned all the x rays it does and radioactive contrast they wanted to use. But my questions were never answered and ignored by hospital staff and the test was done anyway. After all the test were done, Nurse practitioner told me to take over the counter heart burn medication. The bill for all this? Nurse practitioner fee alone was 2 grand, blood work was 2 grand, Ct scan was 9 grand, IV bag 500 dollars. It was over 14 grand to be told to take over the counter heartburn medication. The expensive tests requested by the nurse practitioner didn't indicate to try heartburn medication, that was something she knew to try from experience from treating people who suffered the same way I was suffering so why did she request all these expensive and harmful x ray test? Follow the money. Why so much? Because uninsured people get hit twice. They are punished with uninsured health penalty tax and with the full price of the Hospital Charge Master list. The Charge Master prices are often 10x or more the cost the hospital pays. Excellent time magazine article available on kindle for 99 cent call Bitter Pill talks about all this. There is also a excellent video called Wait Till Its Free. So in truth Medicare aka the government gets the best discount off the hospitals highly over infalted Charge Master prices and pay 35 percent but Joe public thinks the government is being billed the charge master prices. Your Gold health insurance you pay dearly for gets you a 40 percent discount on the charge master prices but again Joe public sees the charge master prices and think the insurance is paying the rest. Its a win win win scam situation for the Hospitals, health insurance companies and the government because even at the government paying 35 percent of the charge master price the hospitals are still making money profits, Hospitals are making even more profit money with insurance discount so all the health insurance companies are doing is giving Joe public a discount on the over priced hospital prices and hosptials really making money off the poor uninsured by charging them the full charge master prices. Sure I got a offer of 20 percent discount for paying in full and being uninsured. What a joke. But here is where uncle same wins too....the highly over inflated charge master prices gets write off by the hospital and then uncle SAM can come after you for taxes for the unpaid hospital bill. Also hospitals can get judgment to put liens on your property and garnish you checks. So seeing how this is huge money, I now know why none of the Over the counter medication books, home doctor books, dealing with hospital books, dealing with medical billing books have been helpful in my situation or to avoid the situation. Who wants to help Joe public when everyone else is getting rich off of him. So in truth, everything you worked for your whole life is at risk of being ripped away from a hospital visit you need to stop the pain or under threat of death. This book MEDICAL BILL SURVIVAL WORKBOOK did help me find some billing errors and that would've saved me alot of money but both the hospital and ER doctor refused to make the correction or admit to any errors. In particular it was level billing errors. The doctor charged at a Level 5 and the hospital charged at a Level 4. Right off the bat the hospital bill dispute response letter I received it said that its review of the bill DOES NOT ADDRESS MEDICAL NECESSITY OR THE REASONABLENESS OF ANY CHARGE. But only looks at the medical records and compares it to what was done to the sucker aka patient. The hospital contracts with doctors to work the ER so even in a in network health insurance covered ER visit you can still be hit with a big doctor bill...my nurse practitioner was 2 grand for less than 30 minute face to face time. Hospital claimed Level 4 bill was correct because the doctor ordered a CT scan which to my understanding now days are given to patients like candy because its a big money maker for hospitals. Do hospital workers know how much their unnecessary services hurt patients financially becuase I don't think they would be able to sleep at night?In short with the guidance of the medical bill dispute book...your hope is to find incorrect amount billing for what was charged versus for what was done or given to you and that takes inside knowledge to know and to catch these types of billing errors. For example you may be billed for a spark gap conductors procedure and see another charge for short burst dc conduits procedure on the same hospital bill. You would have to know the medical terminology of what they are talking about and what materials are used and what is typically done in such procedures to be able to know or dispute the charge. In this example case a mechanic or someone with experience with car repairs would know that its standard procedure to replace spark plug wires with the spark plugs and thus should not be two totally separate more expensive charges instead of one all inclusive charge. Then Joe public has no influence once he does find a dispute error. Uninsured Joe public are completely powerless. The best that health insured Joe public can hope for is to instigate a fight between the 800 pound hospital gorilla with the 800 pound health insurance gorilla by pointing out the fact that the hospital gorilla took one to many bananas from the insurance gorilla in excessive fees and charges and thus it helps insured Joe public by lowering his total medical bill in which he has to pay out of pocket. It would be a huge help to find a book or article of the 10 most commonly prescribed Over the counter medications prescribed for emergency room visits. That way a person would know what to try before even stepping foot in a hospital ER. But I could not find such a thing and if anyone does please list the google search words used find it and specific names in the article so others to find it too. Here is a list of other useless books that I spent money on. Hoping to find something that would've been helpful to me to avoid the situation i was in or at least tell me to take heartburn medication for adobmenal pain..The Pill Book Guide to Over The Counter MedicationsER: Enter at Your Own Risk by Dr. Joel CohenThe Peoples Medical Society Health Desk ReferenceThe over-the-counter doctorGetting the Most for your medical dollarOver the counter drugsRoberts Practical Guide to Common Medical Emergencies by James R. Roberts M.D.You hear Steve Brill's intelligent voice, his thought process throughout this fascinating and highly informative book. It is not only about the ramshackle and over-costed U.S. Health care industry and the actual degree of impact of Obamacare. He also makes it clear why the Affordable Care Act struggled so hard to come into being and why anything value-adding, wise, or efficient so rarely, if ever, can emerge from Washington.Brill is perhaps the best writer on the byzantine world of American health care today. This is a must-read account for anyone interest in understanding the real stories of Obamacare, stripped bare of much of the partisan hype on both sides. The main thrust, corroborated by multiple other accounts, is that the deeply dysfunctional American political system, awash with money and special interests that control the legislative processes, forced the Obama team to make the fumbling attempt to cobble together a "rube goldberg" mishmash of policy fixes. They were obliged to forego the tried and tested methods of other systems throughout the rest of the developed world---with their state run core provision of universal health care with a single payer---systems which produce consistent better health outcomes at much less cost. Instead, the combined effort of the White House and Administration team plus a congressional team led by Senator Baucus, was focused on obtaining bi-partisan and special interest support for the extension of coverage to at least some of the vast pool of uninsured Americans. The result failed for many reasons: at the end of the day, it was politically impossible for any Republican legislator to sign on to any Democratic proposal; the special interests, led by the pharmaceutical and insurance companies diverted the reforms to ensure their own very considerable profit; and the policy gurus in the Administration acted as though it were beneath their dignity to pay any attention to the little matter of execution, which was monumentally botched. The result, in Brill's judgment, is a terribly complicated overlay which should, indeed, somewhat extend coverage but at a tremendous cost in government subsidies going ultimately to the pharma and insurance sharks. Recommended ready for anyone interested in going beyond the rhetoric.