Charlie Rose

BrownGold  02/28/2013 01:26 PM Report

Really great.

Mr. Brill does not emphasize,however, that we just had to DO something. Although Obamacare does not address cost, we had to start. Considering the behemoth at our throats, the for-profit motive in healthcare delivery, we had to first get people access.

The movement in getting access to healthcare thanks to Obamacare will then allow us to tackle the cost. Mr. Brill's article might not have happened without the ruckus Obamacare started. His piece is a major step toward transparency.

In my work, I see the people "on the ground" -- the insured guy who went bankrupt because his insurance didn't cover all the bills from the birth of his premature twins; the uninsured Type 1 diabetic 23 year old who tried to save a little money by cutting back on her insulin at night. She thought she had the flu, slipped into a coma and died.

And then there was the guy who fixed our tvs for 30 years. When the company folded, he took a job delivering pizza. No insurance. No way to get a new battery for his defibrillator. One day he was driving, put his car in park, slumped over the steering wheel of his car and died. He knew the faulty device in his heart trying to kickstart his heart would fail. It did.

In life, we don't turn an ocean liner on a dime. Obamacare is a start. We can just not wait anymore for change.

DonnaL  02/25/2013 03:05 PM Report

Thank you, Mr Brill. Thank you, thank you, thank you.

winter  02/23/2013 05:25 PM Report

Nominating Steven Brill for a Pulitzer. If The Pulitzer Prize has anything to do with public service in the way of improving the greatest number of peoples lives then theres no better example of that in this work.

Imagine charging $4,000. for a walk on a treadmill with EKG and respirator attached. Must've included diagnosing results but I didn't go thru with it. That charge after an inconclusive $1,000. charge for the same minus respirator. I've resolved myself to dying of whatever might visit me and have any treatment eviscerate our nest egg. So we've arrived at where courtroom justice has been said to, there's no alternative to being wealthy. The multi million dollar salaried executives aren't getting a dime out of me. Put it in writing.

YNHow  02/23/2013 04:27 PM Report

Great discussion, great topic. Gerat iniative by Mr.Brill...« wait aminute, why this obvious thing is how it is »...so we need journalists for a healthy society. aspirin thing is great. almost funny.

Overall, I dont know if this is ultimately because of the central bank, but there is one thing for sure. The private sector, in any field maybe has only one purpose. I think everyone know the answer.

Cannot find the interview with Harvard prfessor in comment but seemed like if Mr. Brill was stating symptoms, this professor was tackling the root of the disease.

Lrm  02/23/2013 05:29 AM Report

This is the most intelligent discussion of the health care crisis I have ever witnessed. A great start towards a real solution.

SharkswithfrikingLazers  02/23/2013 03:21 AM Report

4 times more spent on lobbying for healthcare than military industrial complex.

SharkswithfrikingLazers  02/23/2013 03:17 AM Report

Indeed let us go to Fareed:

JUST 5 PERCENT OF AMERICANS ACCOUNTED FOR HALF OF THE NATION'S HEALTH CARE COSTS IN 2009.

ZAKARIA: Brenner had been mapping crime data to locate the city's most violent corners. Just like the New York City Police Department did in the '90s, producing great success. So he started mapping health care spending, identifying hot spots, where the costs were the highest. Using medical billing records, Brenner found the that just 1 percent of the patients accounted for 30 percent of health care costs in Camden.

And that's not all he discovered about the city's three hospitals.

BRENNER: We learned that someone went 113 times in one year, someone went 324 times in five years. In similar work up in Trenton, they found someone who went 451 times in one year.

ZAKARIA: These were people with complicated medical histories and chronic illnesses. One patient alone racked up $3.5 million in medical bills over a five-year period.

BRENNER: They are the difficult patients to treat, and no one is being paid and incentivized to pay attention to them.

ZAKARIA: What's more? Camden's problem is America's problem. Just 5 percent of Americans accounted for half of the nation's health care costs in 2009. This is perhaps the crucial statistic to understand about America's health care problem.

JUST 5 PERCENT OF AMERICANS ACCOUNTED FOR HALF OF THE NATION'S HEALTH CARE COSTS IN 2009.

http://transcripts.cnn.com/TRANSCRIPTS/1211/22/fzgps.01.html

SharkswithfrikingLazers  02/23/2013 03:10 AM Report

Brill spent seven months analyzing bills from hospitals, doctors, drug companies and every other player in the American healthcare ecosystem.

(Yes, we know Obamacare is Accessible Healthcare not Affordable Healthcare.)

The 36-page investigation, the longest single piece ever published by a single writer in TIME, reveals the shocking degree to which we enrich pharmaceutical companies, medical device makers, hospital administrators, laboratories and medical suppliers with lavish profits at the expense of patients.

(Well not really that shocking. It is pretty obvious. Has been for decades. I remember Ted Koppel doing a piece on Nightline.)

Brill explains that hospitals arbitrarily set prices based on inconsistent and subjective lists known as ‘chargemasters.’ These prices vary from hospital to hospital and are often marked up as much as 10,000% the actual cost of an item.

(Yes, like the $640 toilet seat. Perhaps a POGO or is that already Medicare? http://en.wikipedia.org/wiki/Project_On_Government_Oversight)

Medicare by law can pay hospitals only the approximate costs of care. It’s Medicare, not Obamacare, that is bending the curve in terms of costs and efficiency. Brill argues that lowering the age of Medicare entry, not raising it, would lower costs. And that allowing Medicare to competitively price and assess drugs would save billions. Asking wealthy Medicare recipients for higher co-pays would also make sense.

(Brill, you know you want a single payer.)

SharkswithfrikingLazers  02/23/2013 01:59 AM Report

Many people wrongly believe that Medicare is more efficient than private insurance.

In 2005 Robert Book has shown that private insurers spent $453 per beneficiary on administrative costs, compared to $509 for Medicare.

First, other government agencies help administer the Medicare program. The Internal Revenue Service collects the taxes that fund the program; the Social Security Administration helps collect some of the premiums paid by beneficiaries (which are deducted from Social Security checks); the Department of Health and Human Services helps to manage accounting, auditing, and fraud issues and pays for marketing costs, building costs, and more. Private insurers obviously don’t have this kind of outside or off-budget help.

Medicare’s administration is also tax-exempt, whereas insurers must pay state excise taxes on the premiums they charge; the tax is counted as an administrative cost. In addition, Medicare’s massive size leads to economies of scale that private insurers could also achieve, if not exceed, were they equally large.

But most important, because Medicare patients are older, they are substantially sicker than the average insured patient — driving up the denominator of such calculations significantly. For example: If two patients cost $30 each to manage, but the first requires $100 of health expenditures and the second, much sicker patient requires $1,000, the first patient’s insurance will have an administrative-cost ratio of 30%, but the second’s will have a ratio of only 3%. This hardly means the second patient’s insurance is more efficient — administratively, the patients are identical. Instead, the more favorable figure is produced by the second patient’s more severe illness.

http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administrative-costs/

SharkswithfrikingLazers  02/22/2013 11:33 PM Report

The U.S. health care system comes in at $2.8 trillion.

It is the fifth-largest economy in the world — $2.8 trillion.

It is bigger than the French economy--only $2.77 trillion.

$2.8 trillion!!!

How can any one country be so sick?

Sorry, how can one sector of our economy be so greedy, and take so much of our money, while not making us the healthiest in the world?

SharkswithfrikingLazers  02/22/2013 11:09 PM Report

Check out this chart:

http://en.wikipedia.org/wiki/File:International_Comparison_-_Healthcare_spending_as_%25_GDP.png

And you thought we could be the world's biggest spenders without the world's greatest greed?

Simpletons.

Max83  02/22/2013 08:33 PM Report

Thank you for giving this real journalism a platform.

I hope we read and see more of this.

We have to go after the legal drug cartels.

Crony Capitalism and Corporate Welfare have ruined America.

Let's stop it now.

Thank you again.

winter  02/22/2013 06:39 PM Report

Mr Brill does the audit. Nothing explains the whole story better than an audit and its evident that Mr Brill did his homework and exposes what everyone knows but is left with, a what can we do about it option. Overcharging and profiteering beyond our wildest imaginations, an army of lobbyists the defense industry would be envious of. Mr Brill coins a phrase I've never heard before ..."The Health Care Industrial Complex" . The only thing he didn't find was how The Cleveland Clinic hired Diane Von Furstenberg to design their patients gowns or put their name on the pro basketball teams practise facility. Read "Bitter Pill" the cover story in the current issue of Time Magazine. I only hope this story gets the attention it warrants. But then mere attention alone never solves anything -- its become that entrenched.

deancam  02/22/2013 06:38 PM Report

There are a number of reasons why health care in the US is an abysmal failure: firstly, a most basic business principle has been ignored - competition in the delivery of health care. Over the past century allopathic medicine in the form of big pharma (drugs), the medical equipment industry, the AMA (American Medical Association) and the APA (American Psychiatric Assn) have shut out all competition. Once consumers have control over health care spending and achoice in how those dollars are spent watch costs come tumbling down. The naturopathic health field has been around for centuries and has a far better success rate than the pharmaceutical industry which treats symptoms rather than gets to the root of the cause of disease. Secondly, how can any right-thinking government agency such as the FDA and other government agencies allow people to work for them who either come from or go to the corplrations they are supposed to regulate? Is this not the most flagrant example of conflict of interest? Until these most fundamental principles are dealt with health care as it is currently misnamed will continue to kill millions of people every year.

REMant  02/22/2013 05:15 PM Report

Of course, the administration HAS done a lot of research on this subject and has its own theory, much the same as Mr Brill's. That he hadn't seen it is his problem. But... the reason healthcare costs are high is because (duh) people can't afford it, the same reason why many are things are out of reach (such as college) and the ultimate cause of that is a central bank which prints money, so ppl can buy things in China and elsewhere in he 3d world, and a central government that not only encourages them to do it, but, itself spends a lot of what they print. This makes those who deal in finance and govt richer and those who provide services to them charge comparatively more, leaving the rest down and out in particularly places like New York City. Of course, between their great compassion and conceit, these rich have managed to convince themselves this couldn't possibly be true, and come on this show (which at a minimum they alone should pay for) to blame others they both hate and fear, (and are the source of their urge to exhibitionism). Who else can be to blame, however, I can't imagine.

And of course, those who operate in such a market, may charge as much as they want. Now, it has long been pointed out that patients don't have the expertise either, to knowledgeably purchase healthcare. But the financial is every bit as much as a natural monopoly as the demand for healthcare. I mean, what else can a fiat currency be? As a result, the market for labor in this country is in no way free, and if IT isn't free, how can the market for anything work?

I'd also like to mention that hospitals cannot be entirely at fault when so many of them have had to close or are struggling themselves. Or doctors, who've had to seek shelter in HMOs.

The question is whether a single-payer system will, in the long run, do any better in this environment. But if I were going to adopt a plan to cap prices, I would certainly look at something like Japan's, which operates like Medicare, rather than the British National Health Service, tho there is a lot of fraud in Medicare.