The High Cost of Care

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Photograph by Peter Hapak for TIME

For the first time in our history, we are devoting the entire feature section of the magazine to a single story by one writer: a powerful examination of America's health care costs. The 24,105-word story, reported and written by Steve Brill, inverts the standard question of who should pay for health care and asks instead, Why are we paying so much? Why do we spend nearly 20% of our gross domestic product on health care, twice as much as most other developed countries, which get the same or better health outcomes? Why, Brill asks, does America spend more on health care than the next 10 highest-spending countries combined?

One answer is that health care is a seller's market and we're all buyers--buyers with little knowledge and no ability to negotiate. It's a $2.8 trillion market, but it's not a free one. Hospitals and health care providers offer services at prices that very often bear little relationship to costs. They charge what they want to, and mostly--because it's a life-and-death issue--we have to pay. Have you actually looked at your hospital bill? It's largely indecipherable, but Brill meticulously dissects bills and calculates the true costs. He employs a classic journalistic practice: he follows the money, and he does it right down to the 10,000% markup that hospitals put on acetaminophen. He explains why about one-fourth of our bloated health care spending is overpayment and strips the veneer from of a vital American industry that is not always what it seems to be.

Brill, the founder of Court TV and American Lawyer and the CEO of Journalism Online, is one of America's premier--and most dogged--journalists. Brill, who will be talking about health care on CNN all this week, has worked on this story for the past seven months. "What I learned in doing the piece," he says, "is what I always tell my journalism students: opinions and policy debates are boring and meaningless without looking at the facts, without doing the grunt work of real reporting."

If the piece has a villain, it's something you've probably never heard of: the chargemaster, the mysterious internal price list for products and services that every hospital in the U.S. keeps. If the piece has a hero, it's an unlikely one: Medicare, the government program that by law can pay hospitals only the approximate costs of care. It's Medicare, not Obamacare, that is bending the curve in terms of costs and efficiency. Brill's story is resolutely nonideological, but it resets the terms of one of our most important policy debates. Both sides of the aisle are culpable, as our elected leaders refuse to rein in hospitals and health care providers. According to Brill, there are things that can be done. He argues that lowering the age of Medicare entry, not raising it, would lower costs. And that allowing Medicare to competitively price and assess drugs would save billions of dollars. Asking wealthy Medicare recipients for higher co-pays would make sense. Most of all, health care must be a market in which patients can help control costs by understanding them better. And make sure you look at your hospital bill.

Richard Stengel, MANAGING EDITOR

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