Mark Terry

Thursday, February 26, 2009

A Writer's Dirtiest Word

February 26, 2009
No, I'm not going to launch into a George Carlin routine.

Here's what got me thinking about this. A couple days ago on Lee Goldberg's blog he was complaining that he didn't understand the DVD market because some lame TV show from a couple years ago that only aired about 6 episodes and had ratings roughly equivalent to the National Paint Drying Competition was being released as a DVD box set. Why, Lee wondered, don't they release shows people might want to watch?

There are a number of technical reasons, like newer shows are shot on digital cameras so the cost of going straight to DVD is almost nil in the grand scheme of things.

Although I don't claim to be an expert on this, I immediately thought: because the studio and producers lost money and they're trying to recoup it any way they can.

A couple responders to his post gave these same arguments, but at times the tone of some of them got very cynical, as if making money and recouping your costs is a bad thing.

I'm not one of those people who only does things for money. Obviously, if you looked at my balance sheets, you'd point to my fiction and exclaim, "Mark, WTF?" (My wife doesn't say it, but she thinks it, I'm sure).

Still, it's helpful when you're trying to break into writing, fiction or otherwise, that as a matter of fact, this industry is about making money. I worked in healthcare for a long time and I'm somewhat bemused by Americans' attitudes that healthcare is too expensive, blah, blah, blah. Prior to the economic meltdown these same complainers thought little or nothing of paying $3.50 for a cup of coffee, $7 for a fast food meal, $10 for a movie or $6 for a gin & tonic, but they pissed and moaned about a $15 co-pay on a doctor's appointment. 

(This is increasingly on my mind because I'm in the middle of an article that breaks down just how many patients a doctor has to see in order to pay for his practice's various non-medical malpractice insurance and health insurance for himself and his or her staff, not even including wages and overhead or medical malpractice insurance. You'd be shocked.)

Publishers probably don't become publishers purely for money. If they do, they need to take a course in Remedial Economics (with a refresher course called Introduction to Reality). Nonetheless, even small presses are businesses trying to make money. Publishers like their lattes and tropical resort vacations, too.

There's a lot of haze floating around the publishing industry. Compared to other industries, I don't find its economics all that transparent. Part of that I believe is because it's primarily run by a bunch of English majors. Another big reason is because the returns policies and subsidiary rights policies make it difficult--maybe even impossible--to know just how many copies of a book have been sold at any given time. (If you get a chance, look up any news or trade articles about Clive Cussler's lawsuit against the studio that made the movie Sahara. One of the sticking points became the fact that although Cussler claimed to have sold a specific number of books, something like 147 million, the fact was, there was no real accounting to prove that number. The truth was, nobody really knew, not Cussler or his agent or his publishers scattered around the world. Even bestsellers lists are weirdly vague, with polls taken of a finite number of bookstores based on various different factors--like copies ordered from the publisher versus actually sold to the customer. If you remember, there was some furor over the U.S. census extrapolating population data based on sampling rather than on actual counts--well folks, that's how the publishing industry and bestseller lists work).

As fucked up as the auto industry is these days, I can guarantee you they know how many cars they've sold. They even have people whose jobs it is to go to dealerships all over the world and audit their books. Can you imagine an equivalent system in publishing? Can you imagine Doubleday sending an auditor to the warehouse just to figure out how many copies of John Grisham's The Firm have been sitting untouched for the last 23 months?

So here's the point of all this. We want to know how to get published. We say our story is entertaining and maybe it is. We say it's well-written and maybe it is. We say readers would love it, and maybe they would.

But agents and editors and publishers not only ask those questions, they ask: can we make money on it?

And sometimes I think that's a pretty significant distinction.

Mark Terry


Blogger Jude Hardin said...

...I'm somewhat bemused by Americans' attitudes that healthcare is too expensive, blah, blah, blah.

It's not about $15 co-pays for office appointments. It's about the cost of health insurance and hospital stays.

Most people just can't afford insurance unless it's through an employer. Consequently, there are a lot of uninsured people in the United States. If they're unlucky enough to need, say, an emergency appendectomy, they walk out of the hospital a few days later owing a hundred grand or more. Whoops! There goes the house and any other assets they've worked years to accumulate.

Nobody should have to go bankrupt because of an illness.

This is one of the reasons I voted for Obama. A major healthcare reform is long overdue in the U.S.

5:25 AM  
Blogger LurkerMonkey said...

I'm with Jude on this one ... the co-pays are fine. It's the cost of major treatment and the insurance industry's diligent efforts to deny coverage where it should exist. Coupled, of course, with the stranglehold the pharma and medical device companies have over government regulation and oversight. Hospitals and practices are suffering financially, but the pharmaceutical, device and insurance industries are doing just fine, thank you very much.

But to your point about the publishing industry: I totally agree. After you see enough publications and web sites go under, you become finely attuned to the profit motive. I am one of those poor fools who got caught up in the Tribune bankruptcy -- they owe me money because I write for Tribune properties, and now I'm in bankruptcy court with them.

5:37 AM  
Blogger Mark Terry said...

Oh, I agree with you. Keep in mind that not only do I write primarily about healthcare, I worked at Henry Ford Hospital in Detroit for 18 years. I also have NO health insurance, except through my wife's. But access to healthcare via insurance is a different issue than "healthcare is too expensive." A friend of mine's brother had cancer and needed a work-up on his bone marrow prior to a marrow transplant. He commented to me how expensive the work-up was. I commented that the reasons it costs so much was because it's a largely unautomated procedure, the analysis is extremely difficult and time-consuming requiring the most trained cytogenetics technologists, that it spends a day to three or four days in culture depending on the type of cancer, then spends several hours being harvested, dropped onto slides, stained, processed, then turned over to a technologist who spends anywhere from two to four hours JUST on that patient's slides, which are then imaged, double-checked, a report is written, the report and the images are then double-checked by a senior technologist, which is then passed on to a PhD who triple-checks it, then writes the analysis, this entire process then gets processed again by office help and the reports faxed or transmitted electronically. And then somebody complains that $1000 is too much to pay for it. So I'm naturally skeptical.

I am, however, 100% behind a universal healthcare provision, although I have some idea just how complicated that is likely to be. A couple years ago I was at a talk on healthcare in Washington, DC and the keynote speaker was Senator Peter Stark, and he commented that we already had government-sponsored healthcare, it was called Medicare, and he hoped that they would gradually broad it year after year (by expanding who gets coverage) until everybody was covered. I still think that's largely a good idea.

6:33 AM  
Blogger Mark Terry said...

Well, pharma and med devices comps have their challenges as well, and since many of them are publicly-traded corporations, I'm not sure what the American public wants to be done about them--maybe they want the government to buy them, since we're in a frenzy of doing that at the moment.

Anyway, yes, newspapers are dying. That sucks to get caught in that. Good luck getting at least a piece of your money from them.

6:35 AM  
Blogger Erica Orloff said...

Great post. Where I "see" this coming into play are writers who will say, "I write as good as . . . ." (fill in the blank) and they believe that is reason enough to be published. But whoever that "name" is . . . it is a name and there is a more solid chance that name will make the publisher money. It's simply reality.

I mean, if in my basement I created a soda that tasted "as good as" Coke . . . that's all well and good, but there's no track record, no reason for another soda company to take on my drink. It's business. We may not like it because we put an "art" spin on it. But it's a business.


6:58 AM  
Blogger Erica Orloff said...


On healthcare.

I pay $1100 a month for healthcare.

I went to an OUTPATIENT hospital satellite for TWO x-rays on my lungs when I had pneumonia. Two.


I was done in less than four minutes from start to finish.

The system is SO broken, it's insane.

6:59 AM  
Blogger Mark Terry said...

Good point about track record. Yes, that's true, isn't it. I can write (well, maybe not) a horror novel "as good" as Stephen King's, but in fact, I'm not Stephen King. Bestsellers' names do much of the selling. How they got to that point is a mix of things.

As for your x-rays, yes, that sounds expensive, but my first reaction to "I was done in four minutes from start to finish" was that you might have been, but the x-rays and the emergency room probably were not. Now, ERs are enormously expensive to operate (which is why many urban hospitals wish they could eliminate theirs, they're a financial black hole), but it's a good bet you're paying for more than the 4 minute x-ray. You're paying for the building, the nurses, the x-ray techs, the radiologist who has to sign off on the x-ray, and every bit of paperwork and electronic exchange that goes on to connect you to your personal physician, the hospital, and the insurance company.

7:06 AM  
Blogger Mark Terry said...

Oh, you guys pushed my buttons a bit about healthcare, this is both a personal and professional concern to me. No, I'm not arguing that the U.S. healthcare system is wonderful or even that it's "the best in the world," which is what politicians say, but which is a bald faced lie. What I'm saying is a blanket statement that "healthcare is too expensive" or "healthcare is broken" is to look at a very complicated problem and think there's a simple solution.

Another reason healthcare costs are presumably so expensive is the amount of pro bono healthcare hospitals and clinics provide in this country, when patients can't afford it or insurance doesn't cover it. Hospital ERs handle a lot of indigent care for which they get--nada--except they do, they pass it on to everyone else.

In my 18 years working in a laboratory I can't even count the number of times I heard someone say, "The patient doesn't want to do that follow-up because they can't afford it," and the lab director saying, "Do it anyway." He wasn't padding the expenses, he was providing the best healthcare he thought was possible.

But those expenses have to go somewhere and they often get added onto everything else.

7:15 AM  
Blogger LurkerMonkey said...


Poor newspapers ... I feel for them. But I'd feel more for them if they paid me :)

Anyway, I cover healthcare too, and my wife works in two hospital systems in South Florida. There's no doubt that hospitals are suffering, and non-profit hospitals are dropping like flies. For-profit hospitals are consolidating rapidly, and even they're having trouble in some cases.

But reimbursement is a MAJOR issue. In my wife's departments, it's not at all uncommon for the hospital to eat the costs of a significant percentage of procedures performed because they can't get reimbursed or the insurance will only pay a partial. So yes, even if it is technically difficult, and even if $1,000 is justified to run a cancer series, the problem is that the hospital might not get paid anything for it. This drives up costs throughout the system, as well as bankrupting the patients who are individually affected.

As for the pharma and device industries, I've ghostwritten three books about these guys. I wrote the official history of Pfizer and worked for three years on it. Same with Boston Scientific and Guidant Corp. It was eye-opening, and although my job was to report their "side" of the issue, I came to understand that these companies have the American public by the short hairs. The profit margins are unbelievable in these companies ... and frankly, their R&D argument is pretty much bogus. New drug pipelines haven't returned anything like a decent return in ages. Instead, we're seeing rampant reformulation and, through a revamped drug approval process, easier and faster access to market than ever before with less oversight (COX-2 inhibitors, anyone?). When combined with legal direct-to-consumer advertising, we have a problem.

I don't think these companies should be taken over by the government, but nor do I think they should be able to dictate the terms of their interaction with the public healthcare system. Real oversight into the industry is sorely lacking. Bush's prescription drug benefit was a massive giveaway to the pharma and insurance industries ...

I'm all for some form of universal care, but like you said, I know enough to know it's a devilishly complex issue. But I think if we don't get it right, we're going to be screwed.

7:24 AM  
Blogger Erica Orloff said...

Hi Guys:
Mark . . . my x-rays weren't ER. It was an imaging center. And I "hear" you ostensibly. But I do think there's something "broke" if four minutes of patient care translates to that.

My dim view of health care in the country has been fostered by 25-30 years as a Crohn's disease patient. I saw things that made and still make no sense--and I saw wonderful, dedicated doctors in some cases having to fudge things in order to get me the care I needed. I've also seen crappy physicians but that's another matter entirely.

I am with Jon on this one. I remember being on a regime of 40-60 pills a day. The most expensive ones at the time were not covered by insurance at all . . . at $8 a pill, 8 pills a DAY. Why? Because they were considered "experimental." My doctor used to shove a hundred boxes in a brown paper bag and hand them off to me (samples) like some drug dealer.

The pills? Prilosec. They prevented the harsher drugs I was taking from burning a hole in the lining of my stomach. You can get Prilosec OTC now. The little purple f*ckin' pill. But at the time, the pharmaceutical company had its "lock" on it and they were going to make as much money as they could. That's business. But considering there is NOTHING experimental about it, and it was all a trademark issue . . . it sucks.

7:50 AM  
Blogger spyscribbler said...

My biggest problem with the healthcare industry is not only would I have to spend about $500-700 to insure myself, but as an uninsured person, I'm automatically charged 30% more than an insured person.

More to the point, doctors won't say they can't fix something. I spent $5000 on my foot, and all they did was tell me it wasn't broken. Well, cripes, I could've told them that. I wanted it FIXED, not diagnosed.

Why couldn't he have just told me that I need to see a chiropractor? He charged me $500 a visit to be an asshole and fix nothing.

And then ten years with CFS/FM? They couldn't do a thing. And with all the side symptoms, they kept pumping me with drugs and they all made me worse. I had insurance for three years of it, and then it was just not worth the money.

All the money I've spent on healthcare has been money down the toilet. I think the methodology is broken, not so much the finances. If we fix the methodology, a whole lot of healthcare will be cheaper, will fix things, and we won't waste so much money on drugs and whatnot.

8:34 AM  
Blogger spyscribbler said...

(Poor Mark. He was trying to talk about writing!)

To respond to the writing bit, I look at the publishing industry and wonder if I can make money through them.

8:36 AM  
Blogger Mark Terry said...

Holy canolli! I go to the gym and out to lunch and come back and look what happens! Not for the first time I think I should start a healthcare wonk blog.

last week in Philadelphia I was at what's called the Molecular Summit, where it was two days of talks by pathologists and radiologists and people involved with both, as well as molecular biologists and imaging people, like from Siemens. Several of the speakers had personal stories about, for instance, trying to get proper dosage for drugs for high cholesterol (statins), and how hit-and-miss, trial-and-error it is.

The fact is, despite all our technology, medicine is often an art more than a science. There's a lot of technology coming down the pipeline that might help, but insurance companies are resistant to paying for it--it's often quite expensive partly because it's new, and, I often find this a particularly grim thought:

Physicians have a total of about 40 hours of classroom work in genetics. (If that). And most of the new lab tests are genetic based. A lot of docs just plain aren't trained to know what the hell's going on in medicine today.

9:54 AM  

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