Steven Brill has gotten a lot of attention for his big cover story for Time, Bitter Pill: Why Medical Bills Are Killing Us. In general, I don’t pay that much attention to healthcare policy. The truth is that the issues are clear. The only things that get in the way of good policy are the installed interests and the Republican Party. So I didn’t even hear about the article until Brill showed up on The Daily Show. I was none too impressed.
Brill’s main claim is that hospitals are charging too much for things. Three dollars for a capsule of Tylenol?! I understand that these things are outrages, but they aren’t the main issue. Even the centrality of insurance companies in healthcare delivery isn’t the main issue. The main issue is that doctors make far too much money in the United States. Primary care doctors make 50% more in the US than they do in Germany and Canada; they make almost double what they make in France and Australia. I don’t think anyone is arguing that doctors in the US are better than they are in Germany, Canada, France, and Australia.
And yet, in Brill’s big bad indictment of the healthcare system, the doctors are the heroes. He dismisses the idea of a single payer system because—This is rich!—the doctors wouldn’t make as much money. So we have a system where general practitioners make roughly $200,000 per year, but we can’t have a decent healthcare system because these doctors would suffer if they were only making $150,000 per year. It really is that pathetic.
Note: this has nothing to do with single payer systems. The government keeps doctor salaries artificially high by lowering the supply of doctors through immigration policy and certification standards. I understand that we probably want to keep certification standards high. But why are American doctors shielded from the effects of globalization but manufacturing workers aren’t? I suspect that Brill has never even thought about that question. I’d bet he has friends who are doctors. This is same old thing: one member of the upper (or perhaps upper-middle) class taking care of another.
The United States has two big problems with its healthcare system. Doctors are paid too much and insurance companies increase costs while denying care. It may be unfortunate that a hospital charges $3 for a capsule of Tylenol, but that problem isn’t anywhere near central. You would think in 24,000 words that Brill would have figured that out.