The United States has spent more than $1 trillion since 9/11 to protect our country and respond to acts of terrorism. Brill examines what we’ve done right, where we’ve gone wrong, and the number of security gaps we still need to fill.
The first installment of Steven Brill’s 15-part investigation into Johnson & Johnson.
An investigation into the complicated and costly world of medical billing in the U.S.:
“Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three ‘TROPONIN I’ tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.
“Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.”
Race to the Top has turned a relatively modest federal program (the $4.3 billion budget represents less than 1 percent of all federal, state and local education spending) into high-yield leverage that could end up overshadowing health care reform in its impact and that is already upending traditional Democratic Party politics.
How people are paid at the top in a free-market system has always been a contentious issue, especially in bad times. Babe Ruth’s most famous quip was not about baseball but about salaries. When asked in 1930 if it was right that he should be making more money than President Hoover, he replied, “I had a better year than he did.”