Brill talks through his idea with several other prominent health-care-system C.E.O.s (“doctor-leaders,” he calls them), whose résumés are helpfully elaborated: “Glenn Steele, Jr., a former cancer surgeon and professor at Harvard Medical School,” and Gary Gottlieb, the head of a Boston group “formed by the merger of the area’s two most highly reputed hospital brands, both of which were affiliated with Harvard Medical School.” A system like this, Brill estimates, based on a few back-of-the-envelope calculations, could slice twenty per cent off the private-sector health-care bill.

“It’s mostly sweater weight.” Facebook

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It’s at moments like this that Brill’s book becomes problematic. The idea he is describing is called integrated managed care. It has been around for more than half a century—most notably in the form of the Kaiser Permanente Group. Almost ten million Americans are insured through Kaiser, treated by Kaiser doctors, and admitted to Kaiser hospitals. Yet Brill has almost nothing to say about Kaiser, aside from a brief, dismissive mention. It’s as if someone were to write a book about how America really needs a high-end electric-car company that sells its products online without being the least curious about Tesla Motors.

In a Lewis, this wouldn’t matter so much. “Flash Boys” was criticized by some on Wall Street for mischaracterizing the world of high-frequency trading. But “Flash Boys” explicitly set out to tell its story through the eyes of a renegade trader named Bradley Katsuyama, and the test of the book’s success was whether it captured Katsuyama’s view of high-frequency trading. In a Woodward, the goal is different. A book like Mark Bowden’s “Black Hawk Down”—a Woodward that outdoes even Woodward—sets out to describe things as they actually happened, not things as filtered through one person’s idiosyncratic perspective. The currency of the Lewis is empathy. The currency of the Woodward is mastery—and nothing is more corrosive to the form than the suspicion that the author doesn’t grasp the full picture.

Does the botched launch of the Web site deserve fifty pages? Maybe so. This certainly was something that felt significant at the time. But what we want to know is how much it ultimately mattered, and there is little in Brill’s reporting that sheds light on that question. The Administration built a Web site in order to give Americans access to one of the most complex pieces of legislation in history. The site had lots of bugs, in the beginning, as complicated pieces of software often do. Then the Administration fixed the bugs quickly, and the response was such that the Affordable Care Act reached its enrollment targets. “I was, like, never worried,” Brill quotes Mickey Dickerson, an expert from Google whom the Administration brought in to get the Web site on track, as saying. “It’s just a website. We’re not going to the moon.” Brill wants the Web-site saga to stand for something larger, but in the end what it seems to stand for is the fact that Web sites, in the beginning, sometimes crash a lot.

The Sovaldi example is equally puzzling. A thousand dollars for a pill sounds like a lot of money. But hepatitis C is a costly disease. It’s the leading reason for liver transplants, which are among the most expensive of all medical procedures. A 2013 study published in the journal Hepatology estimated the lifetime health-care costs of the average hepatitis-C patient (when medical inflation was factored in) at more than two hundred thousand dollars. The drug regimens that came before Sovaldi didn’t work very well and had terrible side effects. Brill quotes Sarah Kliff on how much the drug will cost the state of California, but what he doesn’t mention is that Kliff followed up on her initial analysis with another that was headlined, above a picture of Sovaldi capsules, “Each of these Hepatitis C pills costs $1,000. That’s actually a great deal.”

The problem with the pharmaceutical industry is not that it makes too many drugs like Sovaldi. It’s that it makes too many drugs that aren’t like Sovaldi, drugs whose costs vastly outstrip their benefits: cancer treatments that cost tens of thousands of dollars and extend life only minimally, or expensive me-too drugs that perform no better than cheap generics. We certainly need to be smarter about the drugs we use, and Medicare should be relieved of the congressionally mandated restrictions that make it impossible to bargain directly with drug companies. But Sovaldi targets a painful and costly disease with a substantially cheaper, safer, and more effective one-time cure. This is what we want drug companies to do. Of all the examples that Brill could have used to bolster his argument, why did he pick that one?

On May 2, 2009, Brill writes, the domestic-policy group at the White House blindsided the economic team with a second memo. It concerned something called the medical loss ratio, or M.L.R. The medical loss ratio compares what an insurer earns in premiums with what it pays out in benefits. An insurer who takes in a dollar and gives back eighty-five cents has a loss ratio of eighty-five per cent. Jeanne Lambrew wanted to place a floor on every insurer’s loss ratio: if a company kept too much of that dollar—if its M.L.R. fell below eighty-five or eighty per cent, say—it should have to refund the difference to its customers.

“Lambrew was certainly on firm political ground,” Brill writes. One senior White House aide called the proposal a “winner.” The rule would make it impossible for one of the economy’s least liked sectors to make excess profits. The feeling was, Brill says, that “it might end up being the single most politically appealing piece of healthcare reform.”

The economic team, however, wasn’t so sure:

Summers called it a “stupid idea,” and told his people to try to kill it. It was “dumb for us to cap anyone’s profits,” he said, dismissing the idea much the way the legendarily blunt Summers might have taken down a freshman economics student at Harvard who said something in class that he thought was “dumb.”

Summers’s point was that an M.L.R. floor distorted the insurer’s incentives. The argument goes like this: Suppose your doctor sends you to an imaging center to get a thousand-dollar MRI. But then your insurance company calls you and says that it’s found an equivalent provider just down the street that charges two hundred dollars. This, presumably, is what we want insurers to do. The market for medical procedures lacks price transparency and competition, and it’s scandalous that insurers routinely pay thousands of dollars for an MRI scan when the true cost of the procedure, by any metric, is a fraction of that. By taking steps like this, Summers thought, insurers could finally rein in, or even reduce, health-care premiums, which had been rising faster than inflation for years. But it is also highly likely that the insurer will keep a chunk of that eight-hundred-dollar savings for itself, in the form of higher profits. The prospect of higher profits is an insurer’s incentive for going to the trouble of looking for a cheaper MRI. In other words, if insurers do what we want them to do—cut costs and rein in premiums—it is likely that their loss ratios will fall. Why, Summers wondered, would you want to penalize them for doing that?