Bad Medicine

America's Bitter - Pill Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System Steven BrillRandom House, 2015; 528 pages, $28.00 Anyone who has ever been to see the doctor and subsequently received one of those mysterious documents called an “EOB” or “Explanation of Benefits” will appreciate the central tenet of Steven Brill’s tome on the American health-care system: American medicine is overcomplicated and overpriced when compared to that of other nations, for an inferior product. Brill explores this theme by delving into the tortuously complicated tale of the Affordable Care Act, a story of political maneuvering, lobbying, unfortunate compromising, inept leadership, and head-spinning amounts of money. Brill—a lawyer, journalist and entrepreneur (founder of Court TV and the monthly The American Lawyer, among others)—sandwiches his 450 pages of thorough investigative reporting between an account of his own time spent “looking up from the gurney.” Brill’s experience with emergency open-heart surgery to remove an aortic aneurism makes him highly sensitive to the fear that drives medical decision-making. Who, after all, will dispute charges when awaiting life-saving  surgery? And who is willing to settle for a cardiac surgeon who ranks in the 85th percentile, even if he or she is in a less expensive network, when one in the 95th percentile is just down the street? When it comes to health care, Americans aren’t willing to cut corners. Brill begins at the beginning—FDR’s National War Labor Board’s decision in 1943 that health insurance was not subject to wage controls. An employer seeking to lure an employee could offer as much in insurance benefits as necessary. As Brill points out, “The decision released much of the political pressure for reform by allowing a large swathe of the population to start getting protected from healthcare bills, while motivating the unions to oppose government interven
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