The longest article the magazine has ever published, the 24,105-word feature explains the bewildering world of hospital billing. Brill spent seven months decoding the medical bills of real patients in an attempt to understand what patients get for the estimated $2.8 trillion we will spend on health care in the U.S. this year.
Brill found hospitals charging $1.50 for a single generic Tylenol pill, $32 for the rental of a reusable blanket, and $13,702 for a drug that cost the hospital only $400. All are part of a three-tiered system that offers deep discounts to Medicare and lesser breaks to private insurers but charges uninsured individuals full price or more.
“[H]ealth care is – except when Medicare is the buyer – a lopsided seller’s market,” Steven Brill explained in a Reuters article that explain his report. “That became clear at both ends of the money trails I followed – from the patients’ lack of any knowledge of what they were buying or its prices, much less any leverage to bargain over it, to the sellers’ ability and willingness to charge absurdly high prices on everything from gauze pads to ambulance services to cancer wonder drugs.”
Many ostensibly non-profit hospitals are raking in even larger profits than their for-profit counterparts. These profits get reinvested in bigger buildings and more medical equipment, which encourage doctors to order even more tests, which generate even more profit for the hospitals.
“In other words, everyone along the supply chain – from hospital administrators (who enjoy multimillion-dollar salaries) to the salesmen, executives and shareholders of drug and equipment makers - was reaping a bonanza,” Brill said. “The only exceptions, I found, were those actually treating the patients - the nurses and doctors (unless the doctors were gaming the system by reaping consulting fees from drug or device makers or setting up diagnostic clinics in their practices in order to steer patients there for expensive tests).”
“We all know how expensive a trip to the hospital can be,” said Sidney Award judge Lindsay Beyerstein. “Brill’s article is an unusually detailed and multifaceted explanation of why medical bills are so high.”