When journalist Steven Brill first began investigating the American health care system for his article "Bitter Pill," he started in a familiar place: medical bills. What he found shocked him. One patient, for example, paid $2,293 per day just for room and board in a hospital - about ten times more than he would have paid for a hotel room - and had little choice in the matter.
"There's no marketplace at all," Brill says. "The person buying the service has no leverage, no power, and no visibility into the cost."
It's no secret that health care in America is the most expensive in the world, but experts are divided on what needs to be done to bring down costs. For Brill, the answer is increased transparency to restore a balance between the buyer and the seller.
Jon Gruber, professor at MIT and one of the architects of Romneycare and Obamacare, thinks the answer is a little bit more complicated. Transparency works, he argues, when it comes to discretionary commodities, but in emergency situations when there’s no time to weigh options and choose carefully, transparency makes less of an impact.
“If you’re in the ambulance, we need more radical steps,” he says.
In addition to greater transparency, Gruber advocates a nationwide system in which everyone must be insured, as well as major reforms to the way medical personnel are paid so doctors don't have financial incentives to deliver excessive medical care.
While Gruber seeks reform on a macro level, Dr. Eric Topol, cardiologist and Chief Academic Officer at Scripps Health, sees promise on a smaller scale. Topol points to an explosion in technology-- including portable handheld ultrasounds and cell phone apps that can display vital signs, sequence genomes, and acquire ultrasound images -- as a key element in reducing cost.
Topol knows first-hand about technology's ability to deliver quick and inexpensive medical care. When a fellow airline passenger in October 2011 began suffering from chest pain, Topol plugged in a small electrocardiogram to his smartphone, quickly diagnosed the pain as the beginning of a heart attack, and recommended the plane made an emergency landing -- effectively saving the man's life.
The looming problem of health care is a daunting one. As Gruber notes, over the long run, Medicare is $75 trillion in debt and a significant factor in the government's long term budget problem. Topol, however, is optimistic about the future.
“If we can be receptive to rebooting of health care," he says, "we can innovate out of this mess.”
What role should doctors play in reforming American health care? We asked Dr. Topol and Jon Gruber in this exclusive web extra.
- Read Steven Brill's article "Bitter Pill," at TIME magazine [paywall]
- "Eric Topol's Tough Prescription for Improving Medicine," by Gary Robbins
- "The Wireless Revolution Hits Medicine," by Ron Winslow
- "Academic Built Case for Mandate in Health Care Law," by Catherine Rampell