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31 of 33 people found the following review helpful
on November 11, 2013
Written for a general (but thinking) audience, this book could really turn around all public discourse on health care and become a seminal work on the subject.

The divisive health care debate of recent years is centered over WHO should shoulder astronomic medical costs. The issue of taming the exorbitant prices and costs is relegated to the side issue of waste and abuse. David Goldhill takes a new and different approach. He puts aside the standard assumption that health care is somehow exempt from the normal rules of economic activity. He focuses on WHY the costs became so exorbitant in the first place. Goldhill shows persuasively that the costs are the result of the very design of our current medical system, and the only way to bring the costs down to earth is to REPLACE entirely the current economic arrangements of our medicine - both the private insurance system and Medicare/Medicaid.

That's a book of new ideas. These ideas are breakthrough innovative, brilliant, deeply thought through; analysis superb. As with all things new and complex, it requires an effort to understand. If you have any background or interest in economics, even the economics of everyday life, give it more consideration.
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26 of 31 people found the following review helpful
on May 1, 2013
I was a practicing cardiologist in the US for over 30 years. I, as most other practicing cardiologist, was trained and fully believed the prevailing methods of diagnosis and treatment were not only correct but absoluely necessary. Several decades of experience taught me this is not close to being accurate. The majority of medical tests, and much of the treatment,is not only unnecessary, but harmful and/or dangerous. The goal of the majority of providers is to increase total "sales" by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive.

David Goldhill is one of the few authors that have experienced this travesty and is educated and intelligent enough to understand the consequences of this nationwide epidemic and the needless, wasteful, and dangerous care. His ability to sort through all of the "noise" prevalent in the governmental and media diatribe and isolate the real problem as full insurance for everyone is unique. This system is doomed for failure. There will never be enough resources to fund medical care as long as the consumer is not the payer. They will always demand more and the providers are happy to accomodate them.

I have left the US and am presently living in Beijing, China, attempting to establish purely preventive heartcare clinics. This is more general education regarding diet, smoking, sedentary lifestyle, and alcohol abuse. than traditional western medicine. Less income, but certainly more satisfying.
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20 of 24 people found the following review helpful
on March 11, 2013
Who could be against health care for all?! The problem is that the system we have and pushed further in ACA, decouples decisions from individuals and instead gives them to surrogates with strong political pressures to approve any and all procedures. And many other consequences that lead to an ineffective, even harmful health care system and an incredibly expensive one with lots of opportunity for abuse.

This book is an excellent primer and should be required reading for all those in the legislature who make health care decisions. I have no idea if the prescription offered in the book as an alternative is a reasonable one, but I do know it opened up my eyes to some of the devastating problems with the status quo.
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51 of 66 people found the following review helpful
on January 8, 2013
We aren't going to solve our nation's fiscal problems without fresh thinking on health care, which consumes almost 18% of our GDP, with no end in sight to its enormous growth. This brilliant new book reframes the national conversation about health care. Currently the debate is framed around health coverage: who gets covered, how plans compete, what Medicare/Medicaid should and shouldn't pay for, etc. This framing assumes that paying for health care through a surrogate, like a health plan or Medicare, is a priori the only way of doing business in health care.

David Goldhill believes that assumption is in fact the root cause of the problems in health care. A businessman in the entertainment industry, he was blissfully unaware of some of the failings of our health care system--until he encountered them full force with his father's hospitalization and death from infection. He wondered why the healthcare system played by an entirely different set of rules than he did in the business world.He studied the problem for a few years, and this book is the result.

He makes a strong case that surrogates drive costs up and quality down, and our health care system is on a crash-course to devastate our economy. He says that we as Americans cherish the myth that we don't really pay for our own health care, our health plan or Medicare does. That myth, says Goldhill, is the core of the problem in our health care system, and the seed of the solution.

Goldhill's perspective and his proposed solutions are unorthodox and will likely generate some controversy. But given the serious problems in our health care system, this incisive book is critical and a must-read for policymakers on both sides of the aisle.
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6 of 6 people found the following review helpful
on January 20, 2014
Over the last three years, David Goldhill has written an article in Atlantic plus two books on why US health care is so expensive; he proposes a way we could change financing of health care by rebuilding a market relying on supply and demand in which providers and patients are the primary participants. Catastrophic Care, the latest of his publications, and now the only one you need to read, updates and further explores the ideas he presented in the magazine article and first book. A weakness of the Affordable Care Act is its lack of focus on the core problem -- US health care costs at least 75% more than in most other OECD countries. It is true most of those countries have systems involving strong participation and leadership by government. Indeed many progressives regret the ACA didn't create a comparable single-payer system. The author and I would prefer a US system in which patients choose how they want to interact with their primary provider(s) and choose what interventions are right for them based on patient-provider discussions of symptoms, problems and alternate solutions, etc., in which the benefits, risks and costs of each proposed solution are identified. Goldhill makes the case for just a system, identifies how insurance should be redirected to deal with true risks and catastrophes and how fairness can be developed through a system of individual health care accounts financed by individuals and/or employers with government support as required to support those most in need. If we pursued his recommendations, costs should come down because we patients would identify and support the people, institutions and interventions we think do the best job at prices we can afford and accept. The only alternative to using supply and demand to achieve these objectives is for government and institutions to use wage and price controls and create arbitrary limits on supply by doing things done in other countries now, such as paying for dialysis only for patients younger than 80 (France), paying for cataract surgeries only for people who need the operation by reason of their employment(Great Britain)or limiting doctor-patient discussions to only a few minutes (Japan). Such government or institution-directed answers are unlikely to be accepted by US patients and providers. Catastrophic Care is a good place to start exploring an alternate vision for US Health Care that might actually be affordable, fair and more effective.
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5 of 5 people found the following review helpful
on February 4, 2014
Anyone interested in why health care costs so much needs to read David Goldhill's analysis. In short, the problem started in the 1940's when we began to give special tax treatment to company sponsored health insurance. This initiated the separation between payer and beneficiary while inserting the insurance provider between the patient and the doctor. But the fundamental fault is we are using the wrong tool to address the issue. High health care costs are not rare and unusual events, they are certainties. Consequentially they should be addressed not by insurance but by a mechanism for transferring a flow of funds from times of low need to times of immediate need.

Goldhill's solution is not ideological. Both Government Action and Individual Choice have critical roles to play. Government provides a guaranteed annual grant to each individual deposited in a Health Saving Account which the individual can use to pay health care expenses. This money accumulates over the years. If expenses in any one year exceed the total in the account the individual can barrow against future deposits. If the balance in the individual's HSA exceeds certain levels at particular points in time the individual can use a portion for other things. Any final unused balance can be given to persons designated by the individual at death for use in their HSA. Everyone will be required to buy Truly Catastrophic (Tru-Cat) insurance for those truly rare and unusual events when and individual's total life-time health care expenses exceed the total expected life-time Government grant.

It is my wish that every member of the U.S, Congress and every member of every state legislature read this book before considering what to do about our current health care crisis.
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4 of 4 people found the following review helpful
on July 14, 2013
This book was so useful, insightful, and utterly thought-provoking that I dog-eared too many pages for the markings to be of any significance. I underlined particularly striking passages and read aloud parts to my husband and talked about them to family members. In short, I'm a believer. David Goldhill has crafted a book that clearly explains the real problems with our health care system and its associated "insurance" setup (which, he says, is not true insurance but, rather, health care payment plans), including the reasons that "Obamacare" will not solve these mounting (and increasingly costly) problems. But Goldhill doesn't just lay bare all the ways our health care system is failing us; he actually delivers a plan of his own for setting up a system of health plans that will cover all Americans and deliver better care that is easier to access and navigate.

Goldhill was driven to craft an article for the Atlantic a few years ago after he watched his father die from infections acquired in the hospital during treatment for simple pneumonia. After the attention that article received, he went on to research and write this book. As he writes, every one of us in America has health care horror stories of one kind or another: frequent frustrations with insurance, long waits for doctor visits, even experiences of our own or stories about friends or family who have been sickened or harmed while in the care of a physician and/or in a hospital. He asks: when we are "quick on the draw to close down an imperfectly assembled theme park ride or a business serving an E. coli-infused hamburger, why do we tolerate the carnage inflicted by our hospitals? ... An estimated two hundred thousand Americans (are) killed each year by medical mistakes."

Goldhill walks readers through how health care and paying for that care has evolved in the United States, and how we as Americans tend to treat health care completely differently than any other industry from which we would expect customer service and reasonable prices. His position is that health care can and should be run like a standard business, and we as its consumers should expect it to treat us as such: valued customers. But when it all comes down to it, we have allowed health care to not only ignore our needs as customers, but to harm us, even kill us in large numbers -- because we have simply preferred until now not to know the true costs of health care and "insurance."

Perhaps most astonishing are the numbers Goldhill uses to illustrate just how much each person in this country will contribute directly or indirectly to health care over a lifetime; taxpayers contribute a specific, direct amount through each paycheck, but they also indirectly contribute a huge chunk more through other taxes and programs. Read his breakdown on the numbers, and you will be aghast (even sick to your stomach -- but don't go to a doctor or hospital to get better).

Goldhill makes clear that we as Americans will have to face the facts about the numbers and that, unfortunately, it may take a real catastrophe in funding care for us to overhaul the way health care is run and paid for. We must become the true customers of health care, rather than insurance companies: "Health care will respond to our needs only when we force it to."

This book is not only well researched and thoughtfully considered, but it is easy to understand. Goldhill lays out some excellent ideas. I would love to see every one of our political leaders read this book and implement its suggestions. I just fear it will take a crisis until that comes to pass.

- Also posted to San Francisco/Sacramento Book Review
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7 of 8 people found the following review helpful
on May 15, 2013
This is a fantastic book about our health care system, what its problems are, and what needs to be done. He doesn't mess around with politics or emotions (which it seems most such debates are centered around), but goes straight to facts and logic. If you've got a strong political view either way, you might be unhappy at some of his points, but if you're an open-minded logical thinker (which a lot of us would like to think we are), this book is for you.

I'm a second year medical student with a background in economics and business and a strong interest in the health care system. I've read many books on the health care system and reform, and I've never agreed with a book as much as I have with this one.

A must read, and tell your friends.
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4 of 4 people found the following review helpful
on November 4, 2013
Much has been written on what is wrong with the American healthcare system that could fill many volumes, But this (espeicially the first four chapters) is the most succinct and (in my opinion) accurate assessment. The author puts it all together into a very readable format that will enthrall readers who aren't already drowning in this stuff. If you have time for only one healthcare book, this should be the one.
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9 of 11 people found the following review helpful
on February 18, 2013
David exposes yet another side of our crumbling disease management system. When I was finished I recommended we start two systems. One, improving the way we manage disease and the second to begin the nation's journey back to knowing to achieve health and stay there.

I too lost a dad to the disease system. Very well intended people. The "Business of Disease" is evil.
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