Posted February 19, 2015

“America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System”
By Steven Brill

By MAGGIE R. URBAN-WAALA

This book is a means of understanding more completely the sequence of events that led to the healthcare system that is currently in place in the United States and the actors that contributed to its inefficiency, as well as a way to discover if there truly is a way to “put the toothpaste back in the tube.”

This is the first piece of literature that intends to give readers a who, what, where, when and why of the history of U.S. healthcare. It is a long-awaited call out to companies and individuals who have taken and continue to take advantage of our most vulnerable citizens, the ill and enable and encourage our current system to function improperly.

Steven Brill is exactly who should have written this book. A  journalism professor at Yale, his alma mater, Yale, Brill understands the importance of guiding the reader through this informational and, at times, confusing topic with the aid of shocking true-life stories and important quotations from respected politicians, just a few skills that he is quite good at doing due to his experience in investigative journalism.

Brill was the author of Time’s March 4, 2013, Special Report “Bitter Pill: Why Medical Bills Are Killing Us,” for which he won the 2014 National Magazine Award for Public Interest, and was the first article in the magazine’s history to take up the entire feature

Brill had completed several other investigative works previous to this, including pieces such as “After: How America Confronted the September 12 Era in 2003, and Class Warfare: Inside the Fight to Fix America’s Schools.” Brill is no stranger to tackling issues as big as the healthcare system, which he chose to tackle in this book.

While working on his healthcare piece for Time, Brill’s investigations of billing practices revealed that hospitals and their executives were manipulating the system in order to obtain maximum revenue and that, oftentimes, the bills that patients received were racked by procedures that had little to do with the care they needed. Through this work, he was able to place some of the blame on someone that most American’s had never heard of, the “chargemaster.”

I believe this piece was written in order to target and inform a certain demographic: the millennials. Although not stated outright, I find this to be true for several reasons, the main reason being the use of modern, staggering, and attention-grabbing.

Where this book differs from the countless other pieces done on the healthcare system is that this is the first complete, inside account of how President Obama persevered to push through the law, but then was unable to successfully implement it due to staff incompetence and an internal battle in his own party.

Millennials have had a hard time getting involved in the conversation of what is wrong with our current system and how to fix it, because many of them were not around when it began to fail, and do not understand how it happened.

Brill effortlessly guides readers through a timeline spanning around 100 years of the healthcare system through historical facts and, more importantly, a first-hand account of his own experience undergoing a medical surgery and the insurance complications that he questioned himself, not as a journalist, but as an insured patient.

Brill skipped no relevant detail and was able to condense each necessary historical fact into a coherent phrase or quote that explained each thoroughly, most likely realizing once again that his target audience is not one most known for its lengthy attention span.

When reading the book, I feel as if I am sitting down for a one-on-one with Brill, as he tells me of his necessary heart surgery that led him to witness firsthand the sort of care that an average American receives when faced with a life-threatening illness and how he, and the rest of this country, made it to this point.

He admits that even as a skeptic and critic of the U.S. healthcare system, that when faced with an illness such as this, he would pay any amount of money the hospital required in order to save his life. He relates this to most other Americans, stating honestly, “People care about their health a lot more than they care about healthcare policies or economics,” describing why as long as people continue to fall ill for whatever reason, the system that is in place, however unfair, will remain as it is.

There is a passage which concisely describes the actions taken by Roosevelt’s National War Labor Board in the 1910s that ultimately determined how healthcare would be managed, and gives readers a harrowing look at just how little thought was put into the effects of that decision.

Brill explains the board’s decision that health insurance would be ruled a fringe benefit, so employers could lure workers by offering to pay for health insurance and making it unregulated under price controls. He uses a quote by American Enterprise Institute scholar Robert Helms to point out where things went wrong, “There is no indication that the Board debated this policy or made any prediction of its future.”

After giving the readers a clear picture of who it was that ultimately began to let out the toothpaste out of the tube, a metaphor he uses frequently throughout the piece that is a quote taken from President Obama, he points to actors who helped it remain inefficient, and gives credit to those who attempted to make it work.

This book achieved his goal of informing a previously unaware reader of how our system took a different path than that of more successfully functioning systems elsewhere in the world and gives insight as to who is and is not capable of making it work, at a time when presidential elections are right around the corner.

I believe the timing of the release of the book and the facts it contains are meant to tell readers what change needs to happen and who can do so in the near future, as the debt caused by this part of our economy continues to increase, and as millennials must begin thinking of who exactly will be taking care of them as they grow old and sick.

• “America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System”
• By Steven Brill
• Random House, New York
• Hardcover – $28
• Released Jan. 5, 2015
• 455 pages