Obamacare, Yet Again

January 8, 2015

Steve Brill is a journalist/businessman/attorney. He created American Lawyer (a magazine), Court TV, and several other publications. I have been following Mr. Brill since he created American Lawyer in 1979. It was an industry publication and really exposed BigLaw—the world of major law firms—to the rest of us. (My partners and I bump up against BigLaw routinely, but that world is very different from ours.)

Mr. Brill wrote Bitter Pill:  Why Medical Bills are Killing Us for Time magazine in February 2013. His book, America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System was published this past Monday. Here’s Malcolm Gladwell’s review, The Bill, from the just out January 12 issue of the New Yorker. (For those who wonder about my billable hours, the answers are:  they’re up, I read the Time piece when it came out two years ago, I just finished the Gladwell review—even before I read Tables for Two, the restaurant review—and I’m not sure about spending the time to read the Brill book.)

Mr. Gladwell is a terrific writer and, here, he’s written a great review. He takes Mr. Brill to task early for his focus on Ivy League credentials and pompous descriptions of the players. He develops an interesting recent history dichotomy, as between the Michael Lewis and Bob Woodward styles. He tells us “the Lewis brings drama to the prosaic, and notes earlier that in Lewis books “if you remove the titles of the characters and simply identify them by their first names, nothing is lost.” On Mr. Woodward, Mr. Gladwell states:  “Names may be irrelevant; titles tell you what you need to know.”

Styles aside—for a moment anyway—the big takeaway from the review is embodied in these two sentences, describing opposing viewpoints within the Obama Administration in 2009:

The economic team felt that health care could use a good dose of market incentives. The Lambrew-DeParle view, on the other hand, was that health care is different:  the complex nature of the relationship between patients and their health-care providers is so unlike ordinary economic transactions that it can be governed only through cost controls and complicated regulatory mechanisms.

Well, as Market-Based Health Care on 11/22 suggested, I fall into the Lambrew-DeParle camp. Except … Mr. Gladwell mentions Catastrophic Care by David Goldhill. Mr. Gladwell reports that Mr. Goldhill focuses more directly on the fundamental question. (I think Mr. Goldhill’s book may be the one to buy and read.) Mr. Goldhill seems to be making valid points about routine health care. On the other hand, if insurers and Medicare end up paying for the big problems, do we want a system where people can choose to ignore minor stuff until it becomes a big issue.

So! Look, we’ve been digging a hole for a century. Brill and Gladwell are big names, and if a book and a review generate comments and thoughts, G-d bless! The Patient Protection and Affordable Care Act was never intended to be the final answer on health care delivery and financing, and a problem that other first world countries with less hubris solved decades ago will take time here. We’re us, for better and, to often worse! I remain certain even after my periodic examinations of the subject, that in 100 years our great-grandchildren will look on Obamacare as a first step in the right direction. (I am also rethinking my views about markets, at least as they relate to routine care.)

P.S. In the end Mr. Gladwell faults Mr. Brill for failing to illuminate us, telling us Mr. Brill gets lost in the weeds.

He’s trying to be Woodward. It’s not as easy as it looks.

P.P.S. The Gladwell review provides such an uplifting and intelligent perspective on the issues and challenges, when you consider the crap we see from the Rs in Congress. You know, people we elected, we have real problems here; if you can’t focus on trying to solve them, just effing leave. Please!


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