January 8, 2015 5:49 AM EST

This week’s cover story marks the culmination of Steve Brill’s extraordinary journey through the landscape of American health care. He first launched this expedition for the 2013 story that became one of our best-selling covers, “Bitter Pill,” a riveting and often infuriating autopsy of hospital costs. In subsequent stories, he explored the terrain as a reporter–but took a harrowing detour as a patient, winding up in New York–Presbyterian Hospital for open-heart surgery to correct a potentially deadly aneurysm.

Steve’s discoveries now come together in his new book, America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, from which this week’s story is adapted. The Affordable Care Act, he argues, is a case study of a dysfunctional government trying to take on a dysfunctional health care system. “The more I looked behind the point I made at the tail end of the first TIME article–that Obamacare didn’t seem to do much about all the pricing abuses I had identified–the more I realized that this was the overarching story of how Washington really works,” he says. “We have become a country where money seems to govern almost everything in Washington, and those interests that enjoy the most power and money, often abusively, will be able to protect their positions.”

His experience as a patient brought the vast, submerged forces in this debate to the surface: namely the power of fear and emotion when it comes to a health crisis. You can have a deep belief in the efficiency of markets and still doubt whether your own health, or the health of someone you love, is suited to negotiation or bargain hunting. Steve proposes a solution that does not require a change in human nature or the current state of U.S. democracy. Let that be the start of the next national conversation: Now that coverage has been expanded, what would it really take to control the costs?

Nancy Gibbs, EDITOR

LIGHTBOX

James Nachtwey was moved to become a photojournalist by the searing images of America’s civil rights movement, so his recent undertaking–photographing scenes on the set of Selma for Paramount (see one above)–was stirring. “There were moments when I felt I had traveled back in time,” he says, yet “many of the emotions that fueled the historical event were still very much alive.” To see Nachtwey’s images, as well as a video interview with Selma’s director and star (right), visit time.com/selma.

NOW ON TIME.COM

In an exclusive interview with TIME.com, Ford CEO Mark Fields says the world is not yet ready for self-driving cars–despite advances in technology and a proliferation of newly announced options from other automakers. Read more at time.com/fordinterview.

LIFE

The Consumer Electronics Show, which this year featured Bluetooth-equipped baby pacifiers, has come a long way from its earlier incarnation as the International Gadget and Invention Show. See images from LIFE’s coverage of the 1958 exhibition, including this foot-propelled hammock, at time.com/gadgets1958.

Please recycle this magazine and remove inserts or samples before recycling

This appears in the January 19, 2015 issue of TIME.

Contact us at letters@time.com.

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