By Marcia Angell, M.D.
The New York Review of Books, April 23, 2015
America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System
By Steven Brill
Random House, 512 pp., $28.00
Steven Brill has achieved the seemingly impossible—written an exciting book about the American health system. In his account of the passage of the Affordable Care Act (now known as Obamacare), he manages to transform a subject that usually befuddles and bores into a political thriller. There was reason to think he might pull it off; his lengthy 2013 Time magazine exposé of the impact of medical bills on ordinary people was engrossing. But his success also owes much to the Bob Woodward method of writing best sellers about government policy: interviews with hundreds of insiders, many anonymous, some evidently willing to talk to him to increase their chances of being shown in a favorable light.
For example, one of Brill’s principal sources and a great favorite is Liz Fowler, chief health counsel to Senator Max Baucus, chairman of the Senate Finance Committee, which oversaw the legislation. Brill credits her with being “more personally responsible than anyone for the drafting of what became Obamacare.” He is unbothered by the fact that she was vice-president for public policy at WellPoint, the country’s second-largest private insurance company, before taking her job with Senator Baucus, or by the fact that shortly after passage of the law (and a brief stint with the administration), she became head of global health policy at the drug company Johnson & Johnson—even though both of these industries benefited greatly from Obamacare.
By contrast, Brill is appropriately critical of others who used the revolving door between industry and government, such as Billy Tauzin, the congressman who pushed through the industry-friendly Medicare drug benefit in 2003 and then became head of the pharmaceutical industry’s trade association. The excuse he gives for Fowler is that she was not a lobbyist, but that is hardly the point.
In view of his method, it’s not surprising that there is as much political gossip and score-settling in Brill’s book as analysis. Nevertheless, his description of our dysfunctional health system is dead-on. He shows in all its horror how the way we distribute health care like a market commodity instead of a social good has produced the most expensive, inequitable, and wasteful health system in the world. (The US now spends per capita two and a half times as much on health care as the average for the other OECD countries, while still leaving tens of millions of Americans uninsured.) Brill makes it clear that the problems are unlikely to be fixed by Obamacare. For that alone, his book deserves to be widely read.