Long read on US health care woes in TIME: "Bitter Pill: Why Medical Bills Are Killing Us"

A must-read by Steven Brill in Time on the brutality of medical bills in America, for cancer patients and others in need of medical care.


  1. It all boils down to where the money ends up.

    It used to be that doctors in America commanded high prices because of their skill and prestige, but then medical malpractice suits drove insurance prices though the roof. So now doctors charge more and pocket far less, and the profession has lost the appeal it once had. With the profession less desireable than it used to be, fewer people are becoming doctors, driving the supply down, but the accompanying rise in demand is complicated by the already high costs of operating. So patients lose out, doctors lose out, and insurers walk away with the profit.

    Then when the government tries to impose changes on the nation’s medical insurance system, people go into an uproar, because – “Communism!” / “Socialism!” / “Obama!”

    1. And by changes you mean forcing the same shitty system on everyone.  I have no problem with the idea of universal coverage for everyone.  I have a problem taken the same broken shit that we have now and applying it everyone like that’s a viable solution.  Instead of just copy pasta why hasn’t someone important sat down and asked just why is it so damn expensive…

      1. The reason costs are contained in universal systems is that the risk is spread across the population evenly and no one gets better care than anyone else. In a for profit system, people who can pay are given access to limited medical resources they don’t need, people who were sick are driven off insurance rolls, and people who are insured spend about half their premiums to people whose job it is to deny you care. By evening getting everyone insured, it should improve the allocation of resources and reduce preventable disease and thus reduce cost in the long term.

    2. Well, because the insurance industry and its lobbyists help to spin the media and political opposition to its own benefit, which in turn creates the public uproar that believes the message “Communism!” / “Socialism!” / “Obama!”

    3. I have ti disagree with you about “fewer people becoming doctors.” The number of people accepted to medicals school in the US (146 medical schools and if you compare that number to over 3,000 + colleges and universities you can begin to understand why so few MDs enter the health care field annually) has not changed in decades. The number of people accepted and go through the years of medical education is  benchmark set by the American Medical Association. Like in the days of yore, “guilds” rationed the number of available spots. The malpractice suits, like many other kinds of lawsuits was championed by, hmmm… let me see… high-priced attorneys. Much of what is wrong in this country can be traced back to attorneys. Most young people, and that does not mean all medical school students, want to become doctors to help others. Most graduate with several hundreds of thousand student loans and the insurance industry has more to do with the high cost of medical care in the good ole USA than greedy doctors. We could begin a whole new discussion on the cost of big Pharma in this country and exactly why the US government (except for the Veteran’s Administration) cannot negotiate “fair” prices for prescriptions. Insurance companies are in business to make money and the attorneys they employ ensure that they always reap a profit. There is a reason there are few medical offices with just one or two doctors like in the 1950s. Please don’t malign the many people who enter medicine to make a difference and I can assure you there are many, many young people who sacrifice in ways that you cannot imagine to become a doctor in today’s competitive world.

  2. The obvious problem here is the fact that costs within the system are hidden. No-one will release the actual costs, allowing them to create this “Chargemaster” goblin, to whose mercy the hospitals are completely the victims of. Except that this goblin pays for all the new fancy shiny equipment, buildings, and people in the hospital. I wonder, how many of these “foreign patients” actually: 1. come to these hospitals, and 2. pay these prices. I’m willing that their lawyers very quickly determine the upper limit their clients will pay.

    So we have these monopolies, who literally have the lives of their customers in their hands, taking full advantage of every chance to “maximize profit”. Much like the “Death Industry” in the US.

    This story, despite the writer’s inability to avoid directly blaming the Democrats specifically, is very well-written – and scary.

    It only reinforces HL Mencken’s “Every normal man must be tempted at times to spit on his hands, hoist the black flag, and begin to slit throats”

    1. I see no reason we shouldn’t blame both parties. I got about two thirds through the article and I saw no inordinate blaming on the author’s part. Both parties have utterly failed on this issue. As they are paid to; I found the statistics on lobbying spending quite shocking. 

      It’s amazing that we went through all the political nonsense of Obamacare and got… more of the same? A little better, a little worse? Now policies can’t have idiotic annual and lifetime caps. But then all policies will get more expensive. Obama and his ilk never even discussed these problems. Neither did Bush. This isn’t a partisan thing, it’s more about privilege. Politicians and large corporate employees and union employees get gilded policies and the rest of us get? This. Ugh.

  3. I lived this recently myself. I was in a ski accident recently, ended up with some bruises and a mild concussion. I didn’t have any insurance, and I was skiing alone, so despite telling the ambulance I wanted to refuse care (and have a friend come and pick me up instead) I was hauled off to a the trauma center (it’s kind of hard to do much about that when you’re strapped to a backboard. Even if you didn’t have little birdies still circling your head a bit). Where they took an couple of x-rays and sent me home with….bruises and a mild concussion. I wouldn’t even know I’d been seen by a doctor if I hadn’t gotten the bill for one. It was all very wham-bam-thank you ma’am.   Total cost: $17,000.

  4. Wow, you guys are totally screwed over.

    For a few years here in Canada the right wing was beating the drum of privatized health care, making a wide range of bogus arguments and outright falsehoods (such as ‘our health care system is in crisis’, which it isn’t).

    But we still have a universal health care system here.  It has flaws, to be sure, but crikey, not like yours.  3 provinces charge a monthly or annual premium, but everyone gets care.  Hospitals do not exist to make profits but to serve people.

    Yesterday I presented myself at the hospital for a preventive test that involved anasthetic and 30 minutes in the OR. Not much fun, but no bill at the end.  If I had been on the hook to pay it would have been over $6000 – meaning it would not have happened.  Hopefully there is no issue, but if there was I would not have found out about it without the test. 

    How bad does your overall system have to get before someone has enough political juice to tear it down and build something rational?

    1. “How bad does your overall system have to get before someone has enough political juice to tear it down and build something rational?”

      …or leave.  I’m studying retirement options in other countries.  There’s no shortage of places to go with better health care options than those in the States. Modern medical tech is useless if you can’t afford it.  The sad thing is that most Americans are convinced there’s no other countries that can compare.  In a way, they’re right.

  5. So angry.  I’m in the healthcare world.  Been a nurse for almost 20 years.  I know the business model is jacked-up beyond belief.  I know I mainly have luck to thank for medical bills not bankrupting me (so far).

    This story still managed to shock me.

    Here’s a humble suggestion for a disclaimer to be placed on every consent for treatment form:

    “Dear patient: please be aware that there is no transparency, accountability or sanity in our billing practices or the billing practices of our medical vendors and suppliers.  Should you be fortunate enough to have a choice in where you seek medical care, understand that there is no actual free market.  The game is fixed. Resistance is futile.

    Have a nice day.”

    I *insane, stream of conscious rant* .  If this isn’t enough to spark a revolution in the fucking “health-care-industry” –I’m done.  I’m just done.  

  6. Wow! Only 11 comments on this!?!

    The problem is pure profiteering. If it was 1940 and the health care system was the war effort the “chargemasters” would be shot for what they are doing.

    Single payer healthcare insurance, not for profit, is the ONLY remedy for this terminally ill business model.

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