Why Americans can't afford to become sick

The Argument

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

October 10, 2004|By Steve Weinberg | Steve Weinberg,Special to the Sun

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, Donald L. Barlett and James 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 George 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.

Donald L. Barlett and James 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.

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