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America's $3 trillion health care bill

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'America's Bitter Pill' by Steven Brill
'America's Bitter Pill' by Steven Brill
Courtesy of Random House

In 2013, Steven Brill changed the national health care conversation with some difficult-to-swallow numbers. In an investigative piece for TIME magazine, he looked at the real costs behind extravagant hospital bills.

He told the story of 400-percent markups on medications; of administrators with salaries in the millions; and of one woman's brief health scare — sparked by heartburn — that cost her $21,000. "We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy," he wrote. "We spent almost that much last week on health care."

In 2014, however, a very different set of numbers was on Brill's mind. Doctors told him he had a bubble on his heart, and that bubble had a 15 to 17 percent chance of bursting. He needed immediate surgery.

Suddenly, Brill had his own exorbitant hospital bills to investigate.

In his new book, "America's Bitter Pill," Brill digs into the politics and logistics behind the Affordable Care Act, but he does it from his perspective as a patient.

Brill takes readers from his time on the operating table to the halls of Congress, with stops inside CEOs' offices and MRI machines between. He examines the ACA's successes — millions more Americans now have access to health care — as well as its failures.

"The new law hasn't come close to making health insurance premiums and out-of-pocket costs low enough so that healthcare is truly affordable to everyone, let alone affordable to the degree that it is in every other developed nation," Brill wrote.

The sky-high, head-scratcher costs he investigated in 2013 ($77 for a box of gauze pads?) still exist. With the Affordable Care Act, Americans are now just more likely to have the health insurance to cover them. But is that a solution?

On the air

Steven Brill joined Kerri Miller on March 10 to discuss the Affordable Care Act and the state of the country's health care system.

On how his own surgery influenced his views on the healthcare system

It didn't change my views about how irrational the system is, how unaccountable the system is. It just solidified those views and gave me an emotional and a personal perspective as well as the reporter's intellectual perspective that I had before. When you're lying there on the gurney and someone's about to open up your chest with a chainsaw, you're not thinking about money, you're not thinking about what the bill is going to be like. You have no idea what the cost of it is going to be. You pretty much don't care at that point.

On the paperwork waiting for him after his surgery

After I got home, about 2 or 3 days later, I received in the mail 36 different explanations of benefits from my insurance company, in 36 different first class envelopes, which tells you something about how inefficient the system is. 

As I started to open them, I thought to myself: I'm the world's leading expert on hospital bills and insurance bills, this is going to be fun. When I opened the third envelope, it said the following. This is an explanation of benefits from United Healthcare, which is headquartered in Minnesota: Amount billed: $0; amount paid by insurance: $0; amount you owe: $154.20. I looked at it and I looked at it. If nothing was billed, how could I owe $154.20? I turned it over, I tried to decode it, I couldn't figure it out.

As it happened, before I went into the hospital, I had scheduled an interview with the CEO of United Health out in Minnesota ... So as soon as I was able to travel, I went out to Minnesota and I did the interview. ... And then at the end, I reached into my pocket and took out that explanation of benefits and handed it to him. I said: "I'm wondering if you could just help me understand this, I'm having trouble figuring out what this means. How could I be billed $154 if nothing was billed?"

He looked at it and he looked at it, he turned it over, he looked at the coding, and finally looked up and said to me: "I could sit here all day and I could not explain that to you. I have no idea what it means. I don't know why they sent it to you."

I said, "Aren't you they?

That explanation of benefits is the single most common form that consumers receive in what is by far the largest industry in the United State: The healthcare industry. Tens of millions of those explanations of benefits go out from United Healthcare every year, and the head of the company can't even understand what it means, so how are the rest of us supposed to understand what it means?

On the good and the bad of Obamacare

The good news about Obamacare is that tens of millions of Americans got access to healthcare that they didn't have before, which is a great thing. The bad news is that they got access because the government is subsidizing their health insurance premiums in order to buy coverage for care at the same ridiculous high prices ... that we've had for the last decade. That's the bad news. 

On the medical device tax controversy and its Minnesota roots

The medical device tax is a 3% tax on the gross revenue of all the medical device makers, the people who make artificial knees and hips. We spend more money in this country on artificial knees and hips — 60% more — than Hollywood takes in at the box office. We spend much more per capita than any other country in the world by far; The prices are higher and doctors prescribe these things much more often. 

It was suggested that one of the ways to finance the subsides on the exchange, since Obamacare is going to deliver tens of millions of new customers to the medical device companies, who will buy these expensive products, was to have them chip in by paying a 3% tax. The medical device companies, led by Medtronic, said, "Oh my god, if you have this 3% tax, it will kill jobs and it will kill our profits." Al Franken and Amy Klobuchar have chimed in and said it will kill jobs and it will kill profits in a really important industry here. 

Since Obamacare was passed, Medtronic's profit is up 67% and they've added 5,000 people to their payroll. That does not sound like a profit-killer or a job-killer.