13 of 13 people found the following review helpful
5.0 out of 5 stars The word is out - 'the Emperor (health care debate) has no clothes'
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...
Published 28 days ago by Ilya Valkovsky
148 of 212 people found the following review helpful
2.0 out of 5 stars A Mostly Misguided Long Slog
David Goldhill's 83-year-old father died of a hospital-acquired infection in 2007 after being admitted with pneumonia. 'Catastrophic Care' is a new book by Goldhill, largely created by painfully stretching out the six pages of a similarly titled September 2009 article in 'The Atlantic' into his now 384 page book. Worse yet, Goldhill's prescriptives are largely built on...
Published 10 months ago by Loyd E. Eskildson
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13 of 13 people found the following review helpful
5.0 out of 5 stars The word is out - 'the Emperor (health care debate) has no clothes',
This review is from: Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (Kindle Edition)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.
43 of 56 people found the following review helpful
5.0 out of 5 stars A businessman's brilliant takedown of our healthcare system,
This review is from: Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (Hardcover)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.
12 of 14 people found the following review helpful
5.0 out of 5 stars Excellent primer on the unintended consequence of our health care system,
This review is from: Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (Hardcover)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.
14 of 17 people found the following review helpful
5.0 out of 5 stars An author that really knows and understands the complexities of the healthcare (sickcare) industry,
This review is from: Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (Hardcover)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.
8 of 10 people found the following review helpful
5.0 out of 5 stars Eye Opening,
This review is from: Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (Kindle Edition)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.
5 of 6 people found the following review helpful
5.0 out of 5 stars Fantastic Book, more people need to read it,
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.
148 of 212 people found the following review helpful
2.0 out of 5 stars A Mostly Misguided Long Slog,
One major difference - health care is a service with an extremely inelastic demand curve, even without insurance. Stated alternatively, increased health care competition, ceteris paribus, doesn't drive down costs, it simply makes things worse as the added entrants make more services more readily available, as well as encouraging their use. Health care economists have demonstrated that repeatedly.
A second significant deviation from standard economic assumptions - despite author Goldhill's example of the benefit of price-shopping for an MRI, it is very difficult to compare prices in health care, even more so when one wants to take quality into account. I've recently verified that personally in instances involving dental care ('depends on the case; we have to see it, and that will cost $X'), and medications (depends on your insurance coverage, and few pharmacies want to take the time to provide the data). As for outcomes/quality, a major determinant is provider volume ('practice makes perfect') - difficult to ascertain unless your state collects provider-specific procedure-specific data, makes it available, and you happen to be a skilled programmer. (I've done this in Arizona, but the state has since stopped collecting and making that data available.) New York State does an excellent job of making data available - for CABG surgery, and the death rates have dropped sharply since the first publication. Published peer-rankings are much better than no information at all, but subject to distortion by provider personal popularity. One cannot even rely on disciplinary actions by the local Board of Medical Examiners - investigators have repeatedly found them loathe to take any action, except when several patients die while treated in a non-hospital setting, or some sort of sex-crime is involved.
A third major deviation from standard economics - health care generally lacks informed consumers. Part of the problem is eg. pharmaceutical company shenanigans, leaving out unfavorable data, testing only selected populations, failing to look for long-term side-effects, comparing with dosage levels for other drugs known to be ineffectual, etc. More importantly, few people are going to contravene physicians (highly regarded by most) in a complex case - his/her financial incentive is try most everything, and patients are likely to agree; those that choose to limit the care provided risk being labeled as a 'quasi-death panel' and sued.
To be fair, Goldhill does call for increasing the collection and dissemination of data on costs and outcomes; unfortunately, he also pans the ACA's ('ObamaCare,' aka the Affordable Care Act) mandate for electronic data collection, failing to see the obvious link between the two. True, electronic medical records have not proven to lower cost yet, but several entities (most recently Mayo Clinic and United HealthCare in a joint venture) plan significant mining of this new source in the hope this will help identify the most effective treatments. Further, its already proven useful in detecting drug interactions.
Thus, Goldhill's recommendation that patients' shop around and research more cannot be scaled up to an impactful level. As for his suggestion that workers be incentivized to switch form PPOs to HSAs (Health Savings Accounts) when beneficial - that simply amounts to moving patients and costs from one pot to another, with no ultimate impact on total system costs; nor does it begin to address the shortcomings of HSAs overall for those with limited incomes.
Two important examples were included by author Goldhill: 1)Medicare's cost-plus pricing can encourage use of high-priced medications/treatment, and 2)a 2007 NEJM article estimated about half the recent decrease in coronary vascular disease was attributable to lifestyle changes (less smoking, better diet, more exercise) and only 7% to expensive treatments like angioplasty and bypass rugery. Both are serious problems and need to be addressed; unfortunately, change in the first area is vulnerable to 'death panel' demagoguery, and history has shown both that changing lifestyles takes decades and reducing the 'moral hazard' posed by insurance hasn't been effective.
Goldhill disparages the ACA's creation of ACOs (Accountable Care Organizations, aka HMOs) and assuming risk, detailing how a hospital would lose revenue doing so. True, but what about an ACA that managed the care but did not include hospitals within its group? (On the other hand, HMOs are very similar, perhaps identical, and have largely failed to control costs - thanks to litigious doctors left out of their networks and 'death panel' fear-mongering by politicians and patient groups.)
Goldhill supports his recommendation for limiting the role of health care insurance via data from declining Lasik prices. True - but Lasik surgery doesn't fall in the category of 'highly inelastic demand' that most health care is, and his example thus is irrelevant.
Goldhill's fundamental error is failing to broadly compare America's health care costs (about 18% GDP, world's highest by far - Switzerland is #2 at only 12% GDP) with other leading nations. Japan, South Korea, and Taiwan are major economic competitors vs. the U.S., and their health care costs are around 8% of GDP. Then Goldhill should have asked, 'What do ALL these other developed nations do differently than the U.S.?' The answer - their governments impose strict price limitations on providers, and in some cases even limit the total spending nationally and by district (eg. Taiwan). Further research in other nations such as Germany and France would be advantageous as well.
Goldhill did compare the U.S. with one nation, Singapore, which spends only 4% of GDP on health care. However, Singapore is somewhat of an exception in that it does not regulate overall charges and expenditures; it does, however, provide government-run hospitals (80% of all hospital care, with 20 - 80% of the costs subsidized for most) and clinics that help keep private provider costs in check. Their Ministry of Health also provides a web-page listing costs for a wide set of conditions and procedures; worker contributions to 'Medisave' is mandated (6.5 - 8.5% of pre-tax income). Singapore also limits prices for all services and procedures delivered in public hospitals - including those for the financially well-off. The government also sets predetermined amounts to be given to hospitals each year - they do not have a blank check to provide an open-ended number of treatments and hospital stays. New, unproven technologies are restricted as to how fast they can be introduced into government hospitals, and the number of beds a hospital can have are also limited. Finally, the government controls the number of medical graduates produced by local universities and the number of overseas medical schools whose degrees are recognized in Singapore, and limits the proportion of physicians that can be specialists (40%).
Singapore's costs continued to rise at an unacceptable rate after increasing the proportion of direct payment from patients (57.7%, in 1995), and did not come under control until the supply-side controls, price caps, and bed limits. Thus, the higher proportion of funds contributed by Singapore patients vs. Americans has little to do with Singapore's success in holding down costs, contrary to Goldhill's claim.
Finally, Goldhill also misses the low-hanging fruit offered by the complexities posed by multiple differing insurance requirements and coverages - simply replace them all with a single payer, single level of coverage plan, such as Taiwan.
Bottom-Line: Author Goldhill is entirely correct that American health care is a mess, but not nearly so when he posits that the providers play no role in creating that mess or blocking its correction, or fail to take advantage of it. Matching Singapore's performance would save about $2.2 trillion/year, wipe out about $30 trillion in unfunded Medicare and Medicaid liabilities, erase much of federal and state debts, and place us at a competitive advantage vs. most other nations. Preventing supply-driven over-treatment, and reigning in free-market forces gone wild are the keys. Goldhill should read Atul Gawande's article exploring Medicare cost differences between El Paso and McAllen Texas. And he couldn't be further from the truth when he tries to apply traditional economic remedies to health care.
2 of 2 people found the following review helpful
5.0 out of 5 stars "We want to believe someone else is paying for our health care.",
This review is from: Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong (Vintage) (Paperback)“We want to believe someone else is paying for our health care.” With that succinct statement author David Goldhill makes you shake hands with the elephant in the room.
Catastrophic Care is unflinching in its assessment of America’s health care challenges. Goldhill fearlessly debunks widely believed myths: that you can’t have enough preventative care, that seniors have paid enough into the system to cover their costs, that the US can simply follow Canada or the EU into a (non-existent) health care utopia. He draws telling and instructive comparisons to the government’s mismanagement of the 2008 housing crisis and the current Medicare system. He makes it absolutely clear that if we do not bring real market forces to bear our health care costs will continue spiral out of control even as quality continues to deteriorate.
Read David Goldhill’s Catastrophic Care if you want to understand – really understand – why the Affordable Care Act will fail. Read it to gain the insight of a man lost his father to a critically broken health care system, who has the benefit of understanding that system as the CEO of a large company, and who has done the research and has the grey matter to devise a better plan. And read it because its down-to-earth prose makes it actually enjoyable to come to terms with one of the greatest challenges of our times – even if the cure is gonna hurt.
2 of 2 people found the following review helpful
5.0 out of 5 stars I wish every American would read this book,
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
15 of 21 people found the following review helpful
5.0 out of 5 stars Warning: Reading this book might make you "think different" about healthcare,
However, if you want a fresh, incisive take on why our healthcare system swallows up so much of our economy and produces care that is unsafe and so often ineffective, read on. His diagnosis is right: patients have been completely ignored by the healthcare system and we have left our health, our healthcare choices, and the quality and costs of healthcare services to "surrogates" -- insurance companies, the government. And those surrogates, despite their good intentions, are not serving us well.
Mr. Goldhill has written a book this is easy to read, even fun to read and I hate to be cliche -- but it will challenge nearly every assumption you have about what is wrong with the healthcare system. In clear and thoughtful ways, he reminds us that its too easy to say "healthcare is different". Healthcare is only different because we have chosen to make it different.
I don't agree with all of it and I suspect you won't either. But, after reading this book, you will never look at another lemonade stand or another bill from your insurance company in the same way again.
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Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It by David Goldhill (Hardcover - January 8, 2013)