Bitter Pill: A Critical Review

                                     Tim Rocah

                                   Tim Rocah

by Tim Roach, Mid-Valley Health Care Advocates, Corvallis

Steven Brill's been making the rounds with media of late, plugging his newest book, America's Bitter Pill--Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System. His recounting of the making of the sausage that is the Affordable Care Act is both interesting and informative, as is his enumeration of its flaws and shortcomings. He is spot on when he focuses on the costs of health care that continue to spiral higher and higher and its related profiteering. I appreciate his reporting of such matters. We are agreed, our nation needs to move beyond Obamacare!

However, when Brill transitions to his final chapter and attempts to speak prescriptively about what we might do to make the best of -- or even "fix" -- our "old jalopy" of a healthcare system, in my opinion, his wisdom fades. For starters, he views America's health insurers as victims of our nation's dysfunctional health care system, rather than major actors/enablers of that system. Furthermore, his basic prescription leans heavily upon a provider-insurer model (with the leadership of such oligopolies restricted to physicians) with government regulation.

As Brill himself describes his script--"Let the foxes run the henhouse -- with conditions." I, for one, see danger and warning signs all over such a scenario. It seems to me that, for some reason, Brill longs to mirror in our health care system many of the same elements that led to the recent fiasco with the nation's banking industry.

Also, it is Brill's contention that such a competitive system between these large provider-insurer oligopolies would result in financial savings. I would disagree with this assumption, feeling that such competition most probably would result in additional costs. I could foresee something of a health care arms race ensuing, as health care systems vie to be the most attractive option in staffing, facilities, etc. and advertise themselves as such.

And, finally, but most importantly, Brill's dream health care system does not provide health care for everyone! Instead, he speaks of offering discounted charges for the uninsured who seek health care services.

While Steven Brill does a really good job introducing us to the creation and particulars of the Affordable Care Act, that's about all I can see that is of value to Health Care for All Oregon and the cause of universal, publicly-funded health care.  In his extended article in the Jan. 19 edition of Time (p. 43), Brill encourages the acceptance of his plan to move our nation's health care system beyond Obamacare, saying " certainly is more realistic than pining for a public single-payer system that is never going to happen."  

I don't see Brill or his latest book as a friend to our universal, publicly-funded cause!  His only point in our favor is that we need to do better than the ACA.  Agreed! Which is what I'd also say about him and his book -- we need to do better!

Tim Roach is a retired Presbyterian minister, living in Corvallis since 2012.  He is the  Vice Chair of Mid-Valley Health Care Advocates, serves on its Communications Committee and is part of the Interfaith Health Care Network.  Tim is a member of the Board (representing faith communities) of Health Care for All-Oregon, and is active with its Speakers' Bureau.