On Saturday, Elisabeth Rosenthal at The New York Times began a story with a description of a woman with diabetes who wears a small digital pump at her waist that delivers insulin to her bloodstream. The insulin keeps her alive; this isn't a high-priced option for a wealthy patient. It's necessary care.
“It looks like a beeper,” the woman told Rosenthal. “It’s made of plastic and runs on triple-A batteries, but it’s the most expensive thing I own, aside from my house.” A new model, Rosenthal reported, can cost tens of thousands of dollars. And the pump and related supplies will cost the woman $5,000 this year, even with good health insurance. That includes insulin that once "cost a few dollars" and "now often sells for more than $200 a vial, meaning some patients must pay more than $4,000 a year," Rosenthal wrote. Part of the reason is that each pump comes with related items that are specific to a particular model. Purchasing a new pump means throwing out other supplies and gadgets and buying a whole new array of equipment.
The story ran under the headline "Even Small Medical Advances Can Mean Big Jumps in Bills." It is the seventh in a formidable series of stories investigating why healthcare costs so much in the U.S., far surpassing costs in other developed countries.
The series began with a piece on colonoscopies that ran June 1, 2013 under the headline "The $2.7 Trillion Medical Bill." It began with the story of a woman whose bill for colonoscopy that found "nothing worrisome" was $6,385. "In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000," she wrote. And it went on to compare other medical costs in the U.S. and elsewhere–and the results were always the same.
Other stories dealt with emergency care ("As Hospital Prices Soar, a Stitch Tops $500") pregnancy ("American Way of Birth, Costliest in the World"), hip replacements ("In Need of a New Hip but Priced Out of the U.S."), prescriptions ("The Soaring Cost of a Simple Breath"), and specialist care ("Patients’ Costs Skyrocket; Specialists’ Incomes Soar").
She also wrote pieces for the Sunday Review section at the Times and follow-up stories in the news section. I had trouble finding all these related pieces, and I asked Rosenthal for help. "We have not (always) been very good at noting that these are related to the series, though we are getting better at that, I hope," she said in an email. "NYT doesn't really have a format for this sort of thing, other than our 'related content' box, which doesn't really explain the connection." The Times might do well to package all of these stories on their own page on its website. The work Rosenthal has done here is far too good to get lost in the daily stream of news at the paper.
Rosenthal pointed me to two other pieces that she was fond of. "I particularly loved doing 'Is this a Hospital or Hotel?'–an article with an online quiz for readers," she wrote. "And (at the other end of the seriousness spectrum) 'Healthcare's Road to Ruin'–an end-of-year news analysis."
Rosenthal didn't say this in her email to me, but elsewhere she explained that after the first story, all of the tips and ideas for further stories came from readers, many of whom told their stories in online comments. In an email to Margaret Sullivan, the Times's public editor, Rosenthal wrote:
There have been tens of thousands of comments on the series and I’ve read most if not all of them. They are a wonderful and intelligent resource for me, as a reporter. They have produced countless ideas for future stories. And they do keep you honest, as people bring up interesting objections to your ideas.
I fear that the enormity of what Rosenthal has accomplished in this series might be lost because the stories didn't run on consecutive days and were not clearly identified as part of a series. The links here will get you to the main stories, and a search of Rosenthal's byline at the Times will get you to the rest.
If you want to understand the soaring costs of American healthcare, you should take some time to read Rosenthal's work. I wish I could say that her powerful explanations of the irrationality and misguided incentives that rule American healthcare would lead to change. But I fear that this is one area in which illumination is not enough to produce change.
-Paul Raeburn
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