Why Americans can't afford to become sick

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Why Americans can't afford to become sick

Expert journalists Barlett and Steele excoriate the U.S. health-care

system By Steve Weinberg Special To The Sun

Originally published October 10, 2004

A just-published expose showing how ineffectively the supposedly

superb U.S. health care system is functioning might play a role in

the presidential election - just as a book by the same author duo

played a role during the 1992 presidential election.

That year, the authors, L. Barlett and B. Steele, won

effusive praise for their book, America: What Went Wrong? They also

became the targets of severe criticism, mostly from those in

positions of power, who disliked the portrayal of how legislators,

presidents, executive branch rulemakers, corporate executives, their

Wall Street financiers and their lobbyists have worked in tandem to

destroy the well-being of middle-class and lower-class Americans.

Some political pundits believe the book helped the campaign of the

challenger, Bill Clinton, while harming incumbent Bush.

The same mixture of praise and criticism greeted their later books,

America: Who Stole the Dream?, America: Who Really Pays the Taxes?

and The Great American Tax Dodge: How Spiraling Fraud and Avoidance

Are Killing Fairness, Destroying the Income Tax, and Costing You.

L. Barlett and B. Steele conducted their first

investigation together 34 years ago, after a Philadelphia Inquirer

editor teamed them. All these years later - after dozens of stunning

newspaper projects, exposes for Time Magazine and its sister

publications, plus best-selling books - Barlett and Steele remain two

of the most talented, controversial investigative journalists in U.S.

history. Steele is 61 years old; Barlett is 68. But senior

citizenship has not dimmed their controlled outrage when it comes to

abuse and fraud. That outrage is apparent on every page of their new

book, Critical Condition: How Health Care in America Became Big

Business, and Bad Medicine " (Doubleday, 288 pages, $24.95).

Critical Condition is certain to bring cries of protest from the U.S.

health care establishment. But the wounded critics are almost certain

to be off base, just as the critics of the earlier Barlett-Steele

books have been. Yes, the Barlett-Steele assertive brand of what I

call " expert journalism " (see below) understandably seems

controversial. My take on the brouhaha: If only all journalists

demonstrated the expertise of Barlett and Steele, the world would be

a better place.

Two other just-published books by physicians who are both former

editors of the influential New England Journal of Medicine give

credence to the Barlett-Steele expose. The Truth About Drug

Companies: How They Deceive Us and What To Do About It is by Marcia

Angell, M.D. (Random House, 336 pages, $ 24.95). On the Take: How Big

Business Is Corrupting American Medicine (Oxford University, 288

pages, $28.00) is by Jerome Kassirer, M.D. Each book is well worth

reading. But each is narrower than Critical Condition, and neither is

as well written.

Why such an outpouring of critical books, given that problems with

health care in the United States seemingly are no longer news? All of

those problems examined by Angell, Kassirer and Barlett-Steele could

be classified as old news - unexpectedly high death rates;

incompetent or impaired doctors, laboratory technicians and nurses;

lack of insurance coverage for tens of millions of Americans;

untrained clerks at insurance companies and health maintenance

organizations that refuse to approve necessary medical procedures

because of bottom-line considerations; overcharges by hospitals and

pharmaceutical companies; overloaded emergency rooms; relentless bill

collectors; unsafe drugs, some of them falsely advertised; uncaring

or hog-tied state and federal government regulation; legislators who

provide superb care for themselves while refusing to approve

meaningful reforms; ownership of health care facilities by investors

who buy and sell to maximize profit.

But when Barlett-Steele write about those problems, almost nothing

seems old. Part of their successful formula is relentless, long-term

reporting that includes human sources and documents undiscovered by

other journalists. Another part of the formula is writing with

anecdotes, analogies and metaphors that elicit reactions like " Wow! "

and " Now I finally understand this issue clearly. " They are able to

minimize direct attribution because of their knowledge, which

contributes to their book's fast pace. They are not shy about

recommending fresh potential solutions because they have become

experts during the reporting and writing.

The opening of Critical Condition is typical of Barlett-Steele leads.

Although they avoid second-person constructions for the most part,

they use them occasionally to directly involve readers at key points

in the narrative. Here is the second-person opening:

" You are standing in a line at the supermarket to buy a box of

Cheerios. You notice that the two customers in front of you are

making the same purchase. The cashier rings up the first box at

$5.41, just as advertised in the newspaper. But when the second box

is scanned, the price registers $6.76. Strange, you think. Even more

strange, the customer doesn't seem to notice the difference. Then

it's your turn. The cashier scans the box and the price flashes

$29.92. Why would anyone pay more than five times as much as another

person for an identical box of cereal? They wouldn't. But when it

comes to health care, you don't have any choice. And that's precisely

the kind of spread that hospitals use in selling their services.

Except that you don't know it - it's their secret. "

Barlett and Steele then mention numerous hospitals employing such

nefarious practices to drive home their point. As for their sourcing,

both humans and documents? They share their sourcing in detail, both

within the text and in the copious endnotes. Expert journalism,

indeed.

As for less-expert journalists, as well as general readers, they are

well advised to study anything - everything, if practical - published

by Barlett and Steele. Their prescient book Forevermore: Nuclear

Waste in America, holds up nicely decades after its publication. And

one of their older classic works is newly available in bookstores,

thanks in large part to Hollywood. Leonardo DiCaprio is starring in

this fall's movie The Aviator, based on the life of eccentric

billionaire inventor-playboy-pilot-paranoid schizophrenic

. Of all journalists who have chronicled ' life and

death, nobody did it better than Barlett-Steele in their 1979

biography Empire: The Life, Legend and Madness of . W.W.

Norton has re-issued the biography with a new title, :

His Life and Madness. The source notes in the book are an

investigative reporting primer. The writing is perhaps the best ever

done by Barlett-Steele. I plan to re-read it, for the fifth time.

Steve Weinberg served as executive director of Investigative

Reporters and Editors (IRE) from 1983-1990. (Bartlett and Steele are

also active in the organization.) Weinberg's investigative journalism

has appeared in several dozen newspapers and magazines. He is the

author of six nonfiction books.

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