Why Medical Bills Are Killing Us

Monday, February 25, 2013

Steven Brill talks about “Bitter Pill: Why Medical Bills Are Killing Us,” his special report in the February 22 issue of Time magazine. It explores why health care costs in the US continue to rise, even as they compromise care and deepen our budget deficits. He spent 16 months working on the article, which is the longest in Time’s history.


Steven Brill

Comments [44]


Some things that prevent fair marketing and billing of health care:

*Differential ability to negotiate among payers (discussed)
*Corporate greed (discussed)
*Drain on system from insufficient Medicare payments (not discussed)
*Drain on system from unfunded mandate to treat indigent ER patients (not discussed)

Single payer is the solution.

Feb. 27 2013 08:59 AM
Noach (Independent, Anti-Corporate Traditionalist) from Brooklyn

Essential, critical health care for profit? Subject to market whims? How did such a concept ever gain as much acceptance as it has?

Feb. 25 2013 02:41 PM
Noach (Independent, Anti-Corporate Traditionalist) from Brooklyn

Below are selected excerpts from Marcia Angell, M.D., former New England Journal of Medicine editor, author of, "The Truth About the Drug Companies: How They Deceive Us and What to Do About It."

____Begin Quoted Excerpts______

Obamacare is simply incapable of doing what it is supposed to do -- provide nearly universal care at an affordable and sustainable cost.[...]So with all the new dollars flowing into the system and no restraints on the way medicine is practiced, the law is inherently inflationary.
The only way to provide health care to all Americans at an affordable cost is by instituting some form of publicly-administered nonprofit system like those in other advanced countries. After all, they manage to provide universal care at less than half the cost, on average, and their costs are rising more slowly.
On July 22, 2009, Obama said in a press conference, "Now, the truth is that unless you have what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual." Bingo. Too bad he didn't hang on to that insight, and use his rhetorical skills to make the case strongly to the American public.

______End Quoted Excerpts___________

Full-text at:

@Pina from South Plainfield:

"I thought it was hilarious!"

Sounds like you were laughing in order not to be crying...

Feb. 25 2013 02:27 PM


Health insurance is NOT healthcare.

Feb. 25 2013 02:08 PM

WHEN DO YOU SHOP AROUND??? On your iFone, whilst unconscious in the back of a $1500 ambulance ride??



Feb. 25 2013 01:59 PM


Feb. 25 2013 01:57 PM
Elisa from White Plains

Eight years ago when my daughter fractured her skull, we started at one hospital and had to transfer to the children's hospital where she was put into PICU. We were told we had to transfer her by ambulance because she was too medically fragile. The ambulance wasn't covered.

The hospital was covered minimally, but the "intensivist" was not-$2500 per night.

The insurance told us there was one intensivist in the hospital who was participating, but you can't choose who is on that night.

The insurance told us that there were absolutely no doctors who administer anesthesia in all of Westchester that were participating.

And this was insurance that we thought was pretty good, since we worked for the NYC.

Feb. 25 2013 01:57 PM
E from Westchester

Do these big corps want to show that some of their hospitals are struggling so that they can gauge costs?

Feb. 25 2013 01:57 PM
John A

Steve from Manhattan,
If a Hospital, just ask to see the billing department. If you are consistently pleasant, they should be equally patient to explain all the odd codes. BTW, try not to have any reactions while you are there, no matter the outrage. Poker game.

Feb. 25 2013 01:56 PM

Stephen Hemsley, CEO, UnitedHealth Group

His take for 2009: $106 million — $7.5 million in salary and benefits and $98.5 million in stock options.


Feb. 25 2013 01:55 PM
thatgirl from manhattan

Thank you, dboy! That is exactly the problem! When medical care in the U.S. needed to "profit," the first pigs at the trough were the heads of "managed" care.

Feb. 25 2013 01:54 PM
Sarah from Brooklyn

I wish preventative care was a consideration for the medical establishment. I have a holistic doctor and Reiki healer and haven't needed traditional care in over two years. I also pay out of pocket for my care.

Feb. 25 2013 01:52 PM
D brandewiede

Do hospitals have to figure in salaries for nurses and doctors or are they paid per procedure?. I believe doctors and nurses should be paid well.

Feb. 25 2013 01:52 PM

I am enjoying listening to Steven Brill very much.

My son went to the hospital in the middle of the night last summer for an emergency appendectomy. Obviously, there was no time for picking and choosing different doctors or different options. When the bills arrived, the total cost for 36 hours in the hospital for an incredibly routine medical matter surpassed $22,000. We do have insurance, but still our out of pocket cost on that was almost $10,000.

One of the biggest headaches and matters of confusion was that the bills came from multiple separate parties. We received one bill from the surgeon, a separate bill from the anesthesiologist, and a third from the hospital. The hospital is on our plan. The anesthesiologist was not, nor was the surgeon. We chose the hospital because it is on our plan, only to find out that not all of the medical professionals who practice there are.

Feb. 25 2013 01:51 PM

@David from Fredricksburg

We shouldn't be wasting money on profits for the parasitic, useless insurance industry.

If we didn't, we'd have enough money to treat everyone, like other advanced countries, instead of robbing Peter to pay Paul...unless Peter is the insurance companies, which simply shouldn't exist.

Feb. 25 2013 01:50 PM
thatgirl from manhattan

Germany also requires everyone to have coverage, and has an exchange of sorts. Coverage is very reasonable, and it actually covers care!

Feb. 25 2013 01:50 PM

Health Insurance Executive Compensation 2008:

Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

Feb. 25 2013 01:49 PM
John A

Insist on a detailed bill.
learn what parts of the test were for what you really needed and what was automatically added. This is unnecessary but important to learn how automatic padding is endemic(?) Next call up, offer half the bill amount and assert that you only needed for example a $400. test set anyway, based on your checking and understanding the bill.

Feb. 25 2013 01:48 PM
Jf from Logic

This is one of the best reports ever! Please rerun!you are truly revolutionary today! Thank you as always for being a utopian.

Feb. 25 2013 01:47 PM
anon from NYC

Did he just say that the insurance company has the most bargaining power in BOTH situations: where there are lots of hospitals AND where there is only one major hospital? That doesn't make sense.

Feb. 25 2013 01:45 PM
Joel from Nyack

What about visits to doctors offices? I noticed on the post visit form from Medicare that my dermatologist charged for two separate procedures when, in fact, he only performed one. (spraying my head with liquid nitrogen to treat pre-cancerous growths.) I intend to question the doctor about this on my next visit.It was paid by Medicare but this is part of the problem, over billing.

Feb. 25 2013 01:45 PM


Feb. 25 2013 01:44 PM
michael from new york

My father was a doctor and director at St Vincents for 20 years, he complained incessantly about the CEO's and corporate BA's who drove that hospital into the ground over the past 15 years and paid themselves 7-digit salaries all the while cutting Dr's fees and hospital services. The poor nuns who ran the hospital had no clue what they were doing and had to hire new (even more highly paid CEO's) to "fix" the mess the previous one made and so on until the hospital went bankrupt.
He and his colleagues saw the closure coming 10 years off and sadly they were right.
Medicine is not a business and it should be regulated because business people are NOT to be trusted. The old Public Health Care system was the best system for care my father ever saw.

Feb. 25 2013 01:44 PM
J Simonelli

My Mother is on Medicare> A recent setback needed her to use a walker. The monthly rental is $15.00. You can buy the walker for less than $100.00. This is a big part of the problem $

Feb. 25 2013 01:43 PM
Steve from Manhattan

Does your guest have anything prescriptive to fix the overall lack of billing transparency?

Feb. 25 2013 01:43 PM
David from Fredericksburg, VA

@ sophia

One small problem. Hospitals & other medical providers can't make it on the oh so wonderful Medicare.

Medicare takes a ride at the expense of everyone else. Hospitals LOSE large amounts of money treating patients on Medicare (and even more on those that have Medicaid). It's patients that have other insurance that have to pick up the slack. Just another way the government buries additional taxes - via the higher insurance premiums you and/or your employer have to pay.

Feb. 25 2013 01:42 PM
Sheila from New Jersey

Please say more about the billing advocate. I did this after my father died in 1996. I didn't know it was a formal position.

Feb. 25 2013 01:42 PM
Stephen from prospect heights

super disappointing answer. I examine my bills & claims and your guest is incorrect, many providers are being ripped off by big insurance.

Feb. 25 2013 01:42 PM
John A

The padding is so automatic that even Steven can't seem to call it padding.
How about calling it Fraud?

Feb. 25 2013 01:41 PM
Ahkey from NYC

My GP who I have used and loved for years joined the NYU Langone Hospital Group.
Unemployed and 3 years since my last physical I called for an appointment and gave full disclosure of my situation.
I was told I would have to pay in full at the time of my appointment, they estimated it would be $600 I went with the cash and Paid $550 on the spot feeling pretty good about it.
2 months later I received an invoice for "tests" from the Hospital (not my GPs practice) for over $2k ... they are relentless and rude and will not discuss the invoice. I don't know what to do ... $550 was a lot for a physical but $3k is outrageous ... I wont pay on principal ... but jokes on me, it has already gone to collection. You cant even discuss it with these people. Is there any option???

Feb. 25 2013 01:37 PM

You know what would address ALL these issues?


The govt is the ONLY entity which can effectively bargain price, yet it is the one option ignored by the pundit/govt class in favor of the fantasy of patients doing it on their own, while sick, and without any sort of knowledge base or power.

Feb. 25 2013 01:36 PM
David from Fredericksburg, VA

Oh yes - those poor put upon insurance companies. Do you know ANYTHING about the absurd salaries of top Health Insurance officials?

Anthem (the commercialized Blue Cross company) simply declares what they'll pay. If a doctor treats a patient & doesn't have a contract with Anthem, Anthem pays the patient directly. They finally let the doctor know 6 months or so later & good luck retrieving the money at that point!

Feb. 25 2013 01:36 PM

...sounds like too big to fail healthcare.

God Bless Amerika™!!

Feb. 25 2013 01:36 PM
Stephen from prospect heights

I feel that the issue is the insurance companies. I examine all my claims. Doctor or hospital charge x amount and typically the insurance company pays only 10%, so maybe health care providers need to intentionally pad?

Feb. 25 2013 01:35 PM
joy from NJ

He is so right...this is one of MANY rackets going on in our midst today, humans are disgusting and slam onto guaranteed money makers like leeches and race it to the bottom....

Feb. 25 2013 01:35 PM
John A

Glad this has reached the level of Time magazine and not just little ole me doing the research. It really is a world of "Just make it up" pricing.
BTW there is also the game of billing for 4 x 7 = 28 Niacin pills when you only took 3.

Feb. 25 2013 01:33 PM
Diana from Brooklyn

I work at a healthcare clinic's billing department and it is really sad how little people truly understand about their healthcare coverage. I believe that no single party is to blame for the situation we are in and we keep digging ourselves deeper.

Feb. 25 2013 01:32 PM
art525 from Park SLope

A few years ago I cut off about a half inch of skin on the tip of my index finger with a Stanley knife. It wasn't a cut but a piece of my finger that was exposed. I walked to the hospital emergency room a few blocks away- Methodist Hospital in Park Slope. In the emergency room they held my finger over a bowl and poured peroxide on it then wrapped my finger in gauze. That was it. The bill was $1000. Needless to say I never paid it. And never heard from them about it. Thankfully.

Feb. 25 2013 01:29 PM
David from NYC

The first case described in the article says that Stephanie "knew" she had to get her husband to MD Anderson and then describes how she had to pay exorbitant fees in order to have husband treated.

The article accepts as fact that only MD Anderson could save her husmand and that she was then taken advantage of.

The article does not say whether there was any basis to her believing that Ohio State University and Cleveland Clinic would not have been excellent options -- and at those places she would have have been treated at the negotiated rate rather than at full retail.

The article discusses a very major issue, but seems to lose some credibility with its sensationalism.

Feb. 25 2013 01:29 PM
Pina from South Plainfield

My mom went to the emergency room with mild heart attack. She stayed 2 nights, and her bill was over $220K. Then she has received her bill which said PLEASE PAID IN FULL. I thought it was hilarious!

Feb. 25 2013 01:28 PM

comment should have ended: can't expect to guarantee a total, healthy human.

Feb. 25 2013 01:27 PM
David from Fredericksburg, VA

While it is true that there are outrageous charges for some medical services - It is ABSURD the way Steven Brill implies that Medicare reimbursement is a good measuring stick. The local hospital here LOSES tens of MILLIONS of dollars caring for Medicare patients. The most recent figure I saw was $65 million dollars in expenses in excess of medicare reimbursements.

Feb. 25 2013 01:25 PM

Since the GOP has not allowed CMS/Medicare to negotiate directly for Part D Rx drugs, medical devices, etc., they shoulder a lot of the blame.

Insurance companies have not agreed on a common standard for claim forms (paper & electronic) which increases provider admin. expenses & delays claims. If they accepted the Medicare/Medicaid forms both providers & insurance companies would save time & money. However, commercial insurance companies still have the habit of denying/delaying claims despite medical needs & have 3-4 times the expenses of Medicare.

For a healthier U.S., we need Medicare/Medicaid for all to cover dental, hearing, medical, mental health, vision & nutrition & physical therapy, etc. + a single individual medical & health record file accessible by providers but with upgraded privacy & confidentiality rules at least on the level of the EU so that the patient has protection. Under our current HIPAA it's Big Pharma/Big Insurance whose access is protected.

Our medical care non-system doesn't cover all the systems in the body, so it

Feb. 25 2013 10:56 AM
Ed from Larchmont

It's interesting that it's health care costs that are causing the budget deficit and all the problems, and with an aging society, no end in sight. Unfortunately Obamacare doesn't address health care costs, providing only government regulation of health care. (And why is the health care system failing - watching hospitals close? Because it hasn't stopped killing the unborn.)

Feb. 25 2013 05:45 AM

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