Exclusive - Steven Brill Extended Interview Pt. 2

  • Aired:  01/16/14
  •  | Views: 42,341

In this exclusive, unedited interview, journalist Steven Brill discusses skewed health care pricing structures and the Catch-22 of insurance subsidies. (6:21)

[ APPLAUSE ]WE'RE BACK AND TALKING

TO STEVEN BRILL.

HE HAS WRITTEN A SERIES CALLED"BITTER PILL" OF ARTICLES IN

TIME MAGAZINE.

YOU WERE MENTIONING HOW THEINSURANCE SUBSIDIES WILL BE THE

TAXPAYERS BASICALLY PAYING TOBRING MORE PEOPLE INTO THE

INSURANCE SCHEME THAT IS ALREADYIN PLACE.

BASICALLY WE'RE SUBSIDIZING THEINSURANCE COMPANIES FOR THEIR

PRODUCT THAT WE DON'T FEELPARTICULARLY GREAT ABOUT.

>> FOR THEY PAY DRUG COMPANIES,HOSPITALS, DOCTORS, MRI

PROVIDERS, VERY HIGH PRICES.

THE INSURANCE COMPANIES -->> Jon: CAN'T THEY BARGAIN.

ISN'T THAT A BETTER SYSTEM THANPEOPLE GOING TO THE EMERGENCY

ROOM, THEY DON'T HAVE ANYINSURANCE, SOMEBODY HAS TO PAY

FOR THAT, ISN'T THAT THETAXPAYERS ALSO?

>> SUPPOSE YOU HAVE ONE HOSPITALUP IN THE NEW HAVEN, CONNECTICUT

AREA.

SUPPOSE YOU WANT TO SELL HEALTHINSURANCE IN THE NEW HAVEN

AREA.

HOW WOULD YOU BARGAIN WITH THATHOSPITAL?

>> Jon: WELL I'D COME IN ANDKNOCK ON THE DOOR AND SAY HOW IS

YOUR FAMILY?

>> THAT IS A WAY.

>> Jon: I WOULD TRY TOINGRATIATE MYSELF TO THEM.

>> MAYBE GOVERNOR CHRISTIE COULDFIGURE OUT A WAY TO BARGAIN...

[ LAUGHTER ]THE HEALTH INSURANCE COMPANIES

HAVEN'T BEEN ABLE TO.

>> Jon: THE HEALTH INSURANCECOMPANY CAN'T GO IN THERE.

DO THEY HAVE AN INTEREST IN THATOR IS THIS SOMEWHAT OF A

CONCLUSIONAL RELATIONSHIP.

I GUESS THE INSURANCE COMPANIESDON'T MAKE THE KIND OF MONEY --

>> THE INSURANCE COMPANIES DON'TINSURE ANYTHING.

THEY ARE CLAIMS PROCESSERS.

A LARGE EMPLOYER IS ON THE HOOK.

THEY HIRE AETNA, WHOEVER JUST TOPROCESS THE CLAIMS.

THE ISSUE IN THE MARKETPLACE ISEVERYTHING ELSE.

DO WE HAVE, YOU KNOW, ANY KINDOF MALPRACTICE REFORM THAT WOULD

STOP HOSPITALS AND DOCTORS FROMHAVING THE REASON OR THE EXCUSE

TO OVERTEST PEOPLE?

DO WE HAVE ANY KIND OF CONTROLON PRESCRIPTION DRUGS THE WAY

EVERY OTHER COUNTRY IN THE WORLDDOES?

DO WE DO ANYTHING IN TERMS OFANTI-TRUST TO DEAL WITH

HOSPITAL CONSOLIDATION? AND DOWE JUST CLAMP

DOWN ON PRICES?

>> Jon: ULTIMATELY WHAT DOESTHIS DO THEN?

LET'S SAY THIS IS THE CASE.

NOW THE INSURANCE COMPANY KNOWSI HAVE AN UNFETTERED SUPPLY OF

NEW CUSTOMERS THAT ARE MANDATEDBY THE FEDERAL GOVERNMENT

TO BUY MY PRODUCT.

>> RIGHT.

>> Jon: WHY CAN'T, IN THE WAY ADISCOUNT

AUTO INSURANCE COMPANYCOMES IN, LIKE A GEICO, WHY

CAN'T THAT OCCUR WITHIN THEINSURANCE WORLD?

LET'S SAY A SMALL LIZARD WITH ANACCENT COMES IN WITH A --

>> THE ONLY WAY YOU COULD DO ITIS IF YOU HAVE ENOUGH SUPPLIERS

TO DO WHAT IS CALLED A NARROWNETWORK.

YOU SAY, ALL RIGHT I'M GOING TOBARGAIN WITH ONE OF SIX

HOSPITALS IN THIS AREA AND I'MGOING TO SAY TO THAT HOSPITAL

I'M SENDING ALL OF MY PEOPLE TOYOU IF YOU GIVE ME THIS

DISCOUNT.

THAT IS HAPPENING IN SOME PLACESLIKE IN CALIFORNIA.

HOWEVER, WHEN THAT HAPPENS, THENYOU HAVE THE OPPOSITION TO

OBAMACARE SAYING, LOOK WHAT IT'SDONE.

NOW YOU CAN'T KEEP YOUR OWNDOCTOR.

YOU CAN'T KEEP YOUR OWNHOSPITAL.

>> Jon: EVEN IN THECASE OF THE FAMILY WITH THE

CANCER PATIENT.

THEY ARE IN A DIFFERENT NETWORKNOW THAT THEY'VE --

>> THEY HAVE GOOD DECENTCOVERAGE BUT THE SIMPLE FACT OF

LIFE IS THAT IF YOU WANT TOLSQUEEZE THOSE PRICES DOWN YOU

MAYHAVE TO DO SOMETHING LIKE NARROW

NETWORKS BUT YOU CAN'T DO THATIF THERE'S ONE HOSPITAL IN TOWN.

>> Jon: WHAT IS THERE TOPREVENT INSURERS FROM CONTINUING

TO RAISE THE RATES?

>> IF THE PREMIUMS GO UP FOR THEPEOPLE IN THE EXCHANGES, GUESS

WHO PAYS?

>> Jon: I'M GOING TO GO WITHUS?

>> I'M LOOKING AT HIM.

YOU PAY.

YOUR TAX BRACKET IS HIGHER -->> Jon: HERE IS THE CRAZY

THING.

I DON'T MIND PAYING FOR THECARE.

I JUST WANT A SYSTEM THAT MAKESSENSE.

IT MAKES SENSE TO ME THAT THEPEOPLE WHO HAVE DONE WELL IN

THIS COUNTRY SUBSIDIZE AT AHIGHER LEVEL A SMART SYSTEM, BUT

WHAT I OBJECT TO IS A CORRUPTSYSTEM THAT IS NOT IN ANY WAY

BEING REFORMED IT'S MERELY BEINGEXPANDED.

>> WE SPEND TWICE PER CAPITA ONHEALTH CARE THAN JUST ABOUT ANY

OTHER DEVELOPED COUNTRY AND OURHEALTH CARE RESULTS ARE WORSE OR

ALMOST AS GOOD.

WE SPEND MORE ON EVERYTHINGWHETHER IT'S AN X-RAY OR CAT

SCAN OR PRESCRIPTION DRUGBECAUSE WE LIVE IN

IN THE ILLUSIONTHAT THIS IS SOME KIND OF FREE

MARKET AND PEOPLE WILL HAVE MORESKIN IN THE GAME AS GEORGE WILL

SAYS.

THAT'S RIDICULOUS.

>> Jon: HERE IS WHERE IT GETSDICKENSIAN YOU HAVE THE STATES

THAT HAVE DECIDED NOT TO EXPANDTHEIR MEDICAID COVERAGE.

NOW YOU HAVE PEOPLE MAKING BELOWTHE LEVEL OF WHERE THEY COULD BE

SUBSIDIZED BUT THEY CAN'T GETSUBSIDIES.

NOW THEY HAVE TO PAY WHAT?

FULL PRICE TO GET COVERED?

>> IF YOU MAKE $5,000 OR $20,000IN TEXAS, YOU WILL BE -- YOU'LL

PAY $800 OR $1500 FOR COVERAGE,WHICH OF COURSE YOU WON'T

BECAUSE YOU CAN'T AFFORD IT.

IF YOU MAKE $80,000 YOU GET ASUBSIDY FROM THE GOVERNMENT.

THANK YOU, RICK PERRY.

IT'S THIS RIDICULOUS CATCH 22.

NOW THE CORE OF IT IS THAT THESUPREME COURT DECIDED WHEN THEY

OK'D OBAMACARE THAT THE ONETHING THEY DIDN'T OKAY WAS THE

FEDERAL GOVERNMENT FORCING THESTATES TO TAKE THE 100% AID TO

EXPAND IT BUT IT DIDN'T SEEMLIKE SUCH A BIG DEAL AFTER ALL

WHAT STATE WOULD TURN DOWN 100%TO COVER ITS POOR PEOPLE.

ANSWER: LOTS OF REPUBLICANSTATES.

>> Jon: REAL AMERICA.

>> YOU SAID THAT NOT ME I'M AJOURNALIST.

>> Jon: EXACTLY.

AND I'M ANGRY.

THE PIECE "BITTER PILL" ITAPPEARS IN TIME MAGAZINE AND

IT'S A MONTHLY COLUMN.

[CHEERS AND APPLAUSE]PLEASE COME BACK AND KEEP

US INFORMED. STEVEN BRILL.

[ APPLAUSE ]

WE'RE BACK AND TALKING

TO STEVEN BRILL.

HE HAS WRITTEN A SERIES CALLED "BITTER PILL" OF ARTICLES IN TIME MAGAZINE.

YOU WERE MENTIONING HOW THE INSURANCE SUBSIDIES WILL BE THE TAXPAYERS BASICALLY PAYING TO

BRING MORE PEOPLE INTO THE INSURANCE SCHEME THAT IS ALREADY IN PLACE.

BASICALLY WE'RE SUBSIDIZING THE INSURANCE COMPANIES FOR THEIR PRODUCT THAT WE DON'T FEEL

PARTICULARLY GREAT ABOUT.

>> FOR THEY PAY DRUG COMPANIES, HOSPITALS, DOCTORS, MRI PROVIDERS, VERY HIGH PRICES.

THE INSURANCE COMPANIES --

>> Jon: CAN'T THEY BARGAIN.

ISN'T THAT A BETTER SYSTEM THAN PEOPLE GOING TO THE EMERGENCY ROOM, THEY DON'T HAVE ANY

INSURANCE, SOMEBODY HAS TO PAY FOR THAT, ISN'T THAT THE TAXPAYERS ALSO?

>> SUPPOSE YOU HAVE ONE HOSPITAL UP IN THE NEW HAVEN, CONNECTICUT AREA.

SUPPOSE YOU WANT TO SELL HEALTH INSURANCE IN THE NEW HAVEN AREA.

HOW WOULD YOU BARGAIN WITH THAT HOSPITAL?

>> Jon: WELL I'D COME IN AND KNOCK ON THE DOOR AND SAY HOW IS YOUR FAMILY?

>> THAT IS A WAY.

>> Jon: I WOULD TRY TO INGRATIATE MYSELF TO THEM.

>> MAYBE GOVERNOR CHRISTIE COULD FIGURE OUT A WAY TO BARGAIN...

[ LAUGHTER ]

THE HEALTH INSURANCE COMPANIES HAVEN'T BEEN ABLE TO.

>> Jon: THE HEALTH INSURANCE COMPANY CAN'T GO IN THERE.

DO THEY HAVE AN INTEREST IN THAT OR IS THIS SOMEWHAT OF A CONCLUSIONAL RELATIONSHIP.

I GUESS THE INSURANCE COMPANIES DON'T MAKE THE KIND OF MONEY --

>> THE INSURANCE COMPANIES DON'T INSURE ANYTHING.

THEY ARE CLAIMS PROCESSERS.

A LARGE EMPLOYER IS ON THE HOOK.

THEY HIRE AETNA, WHOEVER JUST TO PROCESS THE CLAIMS.

THE ISSUE IN THE MARKETPLACE IS EVERYTHING ELSE.

DO WE HAVE, YOU KNOW, ANY KIND OF MALPRACTICE REFORM THAT WOULD STOP HOSPITALS AND DOCTORS FROM

HAVING THE REASON OR THE EXCUSE TO OVERTEST PEOPLE?

DO WE HAVE ANY KIND OF CONTROL ON PRESCRIPTION DRUGS THE WAY EVERY OTHER COUNTRY IN THE WORLD DOES?

DO WE DO ANYTHING IN TERMS OF ANTI-TRUST TO DEAL WITH HOSPITAL CONSOLIDATION? AND DO

WE JUST CLAMP DOWN ON PRICES?

>> Jon: ULTIMATELY WHAT DOES

THIS DO THEN?

LET'S SAY THIS IS THE CASE.

NOW THE INSURANCE COMPANY KNOWS I HAVE AN UNFETTERED SUPPLY OF NEW CUSTOMERS THAT ARE MANDATED

BY THE FEDERAL GOVERNMENT

TO BUY MY PRODUCT.

>> RIGHT.

>> Jon: WHY CAN'T, IN THE WAY A DISCOUNT

AUTO INSURANCE COMPANY

COMES IN, LIKE A GEICO, WHY CAN'T THAT OCCUR WITHIN THE INSURANCE WORLD?

LET'S SAY A SMALL LIZARD WITH AN ACCENT COMES IN WITH A --

>> THE ONLY WAY YOU COULD DO IT IS IF YOU HAVE ENOUGH SUPPLIERS TO DO WHAT IS CALLED A NARROW NETWORK.

YOU SAY, ALL RIGHT I'M GOING TO BARGAIN WITH ONE OF SIX HOSPITALS IN THIS AREA AND I'M

GOING TO SAY TO THAT HOSPITAL I'M SENDING ALL OF MY PEOPLE TO YOU IF YOU GIVE ME THIS DISCOUNT.

THAT IS HAPPENING IN SOME PLACES LIKE IN CALIFORNIA.

HOWEVER, WHEN THAT HAPPENS, THEN YOU HAVE THE OPPOSITION TO OBAMACARE SAYING, LOOK WHAT IT'S DONE.

NOW YOU CAN'T KEEP YOUR OWN DOCTOR.

YOU CAN'T KEEP YOUR OWN HOSPITAL.

>> Jon: EVEN IN THE CASE OF THE FAMILY WITH THE CANCER PATIENT.

THEY ARE IN A DIFFERENT NETWORK NOW THAT THEY'VE --

>> THEY HAVE GOOD DECENT COVERAGE BUT THE SIMPLE FACT OF LIFE IS THAT IF YOU WANT TO

LSQUEEZE THOSE PRICES DOWN YOU MAY HAVE TO DO SOMETHING LIKE NARROW NETWORKS BUT YOU CAN'T DO THAT

IF THERE'S ONE HOSPITAL IN TOWN.

>> Jon: WHAT IS THERE TO PREVENT INSURERS FROM CONTINUING TO RAISE THE RATES?

>> IF THE PREMIUMS GO UP FOR THE PEOPLE IN THE EXCHANGES, GUESS WHO PAYS?

>> Jon: I'M GOING TO GO WITH US?

>> I'M LOOKING AT HIM.

YOU PAY.

YOUR TAX BRACKET IS HIGHER --

>> Jon: HERE IS THE CRAZY THING.

I DON'T MIND PAYING FOR THE CARE.

I JUST WANT A SYSTEM THAT MAKES SENSE.

IT MAKES SENSE TO ME THAT THE PEOPLE WHO HAVE DONE WELL IN THIS COUNTRY SUBSIDIZE AT A

HIGHER LEVEL A SMART SYSTEM, BUT WHAT I OBJECT TO IS A CORRUPT SYSTEM THAT IS NOT IN ANY WAY

BEING REFORMED IT'S MERELY BEING EXPANDED.

>> WE SPEND TWICE PER CAPITA ON HEALTH CARE THAN JUST ABOUT ANY OTHER DEVELOPED COUNTRY AND OUR

HEALTH CARE RESULTS ARE WORSE OR ALMOST AS GOOD.

WE SPEND MORE ON EVERYTHING WHETHER IT'S AN X-RAY OR CAT SCAN OR PRESCRIPTION DRUG

BECAUSE WE LIVE IN IN THE ILLUSION

THAT THIS IS SOME KIND OF FREE MARKET AND PEOPLE WILL HAVE MORE SKIN IN THE GAME AS GEORGE WILL SAYS.

THAT'S RIDICULOUS.

>> Jon: HERE IS WHERE IT GETS DICKENSIAN YOU HAVE THE STATES THAT HAVE DECIDED NOT TO EXPAND

THEIR MEDICAID COVERAGE.

NOW YOU HAVE PEOPLE MAKING BELOW THE LEVEL OF WHERE THEY COULD BE SUBSIDIZED BUT THEY CAN'T GET SUBSIDIES.

NOW THEY HAVE TO PAY WHAT?

FULL PRICE TO GET COVERED?

>> IF YOU MAKE $5,000 OR $20,000 IN TEXAS, YOU WILL BE -- YOU'LL PAY $800 OR $1500 FOR COVERAGE,

WHICH OF COURSE YOU WON'T BECAUSE YOU CAN'T AFFORD IT.

IF YOU MAKE $80,000 YOU GET A SUBSIDY FROM THE GOVERNMENT.

THANK YOU, RICK PERRY.

IT'S THIS RIDICULOUS CATCH 22.

NOW THE CORE OF IT IS THAT THE SUPREME COURT DECIDED WHEN THEY OK'D OBAMACARE THAT THE ONE

THING THEY DIDN'T OKAY WAS THE FEDERAL GOVERNMENT FORCING THE STATES TO TAKE THE 100% AID TO

EXPAND IT BUT IT DIDN'T SEEM LIKE SUCH A BIG DEAL AFTER ALL WHAT STATE WOULD TURN DOWN 100%

TO COVER ITS POOR PEOPLE.

ANSWER: LOTS OF REPUBLICAN STATES.

>> Jon: REAL AMERICA.

>> YOU SAID THAT NOT ME I'M A JOURNALIST.

>> Jon: EXACTLY.

AND I'M ANGRY.

THE PIECE "BITTER PILL" IT APPEARS IN TIME MAGAZINE AND IT'S A MONTHLY COLUMN.

[CHEERS AND APPLAUSE]

PLEASE COME BACK AND KEEP US INFORMED. STEVEN BRILL.

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