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Steven Brill’s Bitter Pill

Bitter PillA New York Times review called Steven Brill's book, America's Bitter Pill, "a thriller." Brill's tome on the building of the Affordable Care Act (ACA), aka Obamacare, "a thriller?" I thought. What recent treatise on the inner workings of public policy has garnered that sort of description? Didn't the term "thriller" belong to writers like Paula Hawkins, Dean Koontz, Gillian Flynn and James Patterson? But Brill's meticulous narrative of how Obamacare was constructed is a public-policy thriller, and the suspense he writes about is how the law was brought from broth to soup.

While Brill is hardly a public-policy advocate (he's a long time investigative reporter), he does laud the president's herculean effort to give millions of Americans access to affordable health care. He just doesn't believe that any of the big "players" in health care - hospitals, device makers, insurance companies or pharmaceuticals -  felt a pinch of economic pain, and he sees America's health care system still as an old "jalopy" financially out of control and enriching special interests.

The seed for the book was spawned in a 24,000-word article in TIME magazine in April 2013. A year later, while reporting on the rollout of the ACA, Brill was diagnosed with an aortic aneurysm - flipping the story and putting investigative reporter onto the operating table as a very real person needing cardiac surgery.

As he told NPR's Terry Gross:

At that moment I wasn't worried about costs; I wasn't worried about a cost-benefit analysis of this drug or this medical device; I wasn't worried about health-care policy. It drove home to me the reality that in addition to being a tough political issue because of all of the money involved, health care is a toxic political issue because of all of the fear and emotion involved.

At the end of my conversation I asked Brill if there was one question he'd been surprised that he'd not been asked during his media blitz, which began with a rollout by Lesley Stahl on CBS' 6o Minutes.  "Yes," he said, "you just touched on it." How would his book had been different if he'd not had an aortic aneurism, a cardiac operation and become a patient? So how would Chapter One have begun?

I hope you'll listen to my latest 1:2:1 podcast to hear what he has to say.

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