We were gathered in a tiny windowless conference room at The New York Times noodling over what was undoubtedly going to be an epic tale of the troubled American health care system. But which epic would it be?
For weeks, Martin Gottlieb, Kurt Eichenwald and Tamar Lewin had traveled around the country meeting with sources, reviewing court and agency records, exploring the troubling business strategies that turned Columbia/HCA Hospital Corp. into a $20 billion health care giant, the world's largest health care provider.
After a few days on the road in places like Tallahassee and Baltimore, I stayed back at the office staring at my computer screen. I was trying to make sense of a carton filled with 89 computer cartridges containing more than 30 million medical billing records perched on the edge of my desk.
As we reviewed our findings - tales of hard-ball takeover practices, questionable incentives for doctors to switch hospitals and bring their patients with them - we struggled over fundamental questions of fairness.
Was this a story about a greedy for-profit company that went way too far? Or a story about the sorry state of the entire American health care system? Was Columbia/HCA a special case or were not-for-profit hospitals, facing the same pressures, doing exactly the same things? Were we picking on the wrong guy?
Analytical evidence
At this pivotal moment in the project, I was able to lean forward on the sagging couch and pull out the computer-assisted reporting analysis of medical billing records. I argued that they provided the strongest and clearest evidence yet that Columbia/HCA was simply different from other hospitals and needed to be treated that way.
The analysis showed that Medicare recipients who were treated at Columbia/HCA hospitals in Texas cost the government millions of dollars more than patients treated at other hospitals. Their costs were higher than costs at all other hospitals, particularly when the entire cost of care included the hospital stay through skilled nursing, rehabilitation and home health care. Their costs were far higher than the costs at comparable not-for-profit hospitals.