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Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong Paperback – November 5, 2013
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Dysfunctional and undisciplined. That is Goldhill’s assessment of the current U.S. health-care system. President and CEO of the Game Show Network, Goldhill believes the trouble stems from “a culture lacking customer accountability: high prices, excess, errors, underinvestment in information technology, lack of follow-up.” Spurred by the death of his father from a hospital-acquired infection, Goldhill has devoted considerable time and thought to repairing health care. His book sprouted from a 2009 article he penned for the Atlantic. Encounters with the health-care system usually involve gargantuan intermediaries—Medicare, Medicaid, and private insurance companies, entities Goldhill cites for inefficiency. They also generate increased demand for services. His alternative to the status quo combines national health insurance (for everyone but not everything) with a market-based system that gets rid of intermediaries and allows individuals to deal directly with providers. Individual health accounts, catastrophic insurance with a high deductible, and health loans are key components. The health-care system is gashed. Goldhill thinks it’s time to rip off the colossal Band-Aid and apply a different kind of balm. --Tony Miksanek --This text refers to the Hardcover edition.
Praise for David Goldhill's Catastrophic Care
“A devastating and utterly original analysis of what has gone wrong with the American health care system. Read it, and take a deep breath. . . . [Goldhill] will convince you that our ‘solutions’ are not solving our problems. They are making our problems worse.”
“Thought provoking. . . . A for-profit business executive who actually states that better than adequate health care should be available to all people in the country. . . . Mr. Goldhill observes and explains the issues in an understandable manner for the layperson.”
—New York Journal of Books
“The best popular health care book . . . a crystal clear account of what has gone wrong and how to fix it.”
—Tyler Cowen, Holbert L. Harris Professor of Economics, George Mason University
“Powerful—edge-of-the-seat riveting—because it is not, in any sense, a policy book. Rather, this is a story about saving ourselves. . . . It steps outside of the established political debate and lexicon—one of the rare books addressing a major national policy issue that is able to do so in language not already debased by the problem itself. . . . Alas, healthcare civilians can't actually read most books about healthcare (and if you can, then you are part of the problem). But you can read this one.”
—Michael Wolff, The Guardian
“David Goldhill is a genius observer of a broken system in need of fresh ideas. His testimony and common-sense ideas are devastatingly important in light of out-of-control medical prices. A must-read for doctors, policy-makers and patients alike. Catastrophic Care is a defining book of our era, and a roadmap for fixing our country's leading debt driver. You will never see medical care the same way.”
—Marty Makary, MD, author of Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Healthcare
“For those who are troubled by both the failures of our healthcare system and the misdirected diagnoses and prescriptions offered by pundits, policy experts, and politicians from across the political spectrum, David Goldhill offers a brilliant and much needed antidote. By calling out with remarkable clarity the numerous, but now almost invisible incentives and regulations that drive the dysfunction of our current system, Catastrophic Care provides an illuminating framework for understanding the crisis, and then a path to the kinds of reforms that will surely be necessary.”
—Jeffrey S. Flier, Dean of the Faculty, Harvard Medical School
“[A] fascinating and infuriating expose of the American health care system . . . Goldhill persuasively argues that a consumer-driven system—which will require greater vigilance and commitment on the part of citizens in actively managing their health—is the first step toward sustainability and lower individual and government costs. . . . Goldhill's reasoned, logical alternative to the current system goes beyond political finger-pointing, and while his take is sobering, it’s one that offers sound solutions.”
“Highly readable presentation of one businessman’s solution, likely to provoke discussion if not agreement.”
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Goldhill takes us on a whirlwind tour of almost literally every facet of care I've never even thought about, from Medicare and Medicaid to the broken rewards systems that are powering the next generation of physicians. Overall, I felt the analysis was incredibly well done and well researched, little was left to the imagination as to why and where our system has failed us, and even though the book itself seems to have come out before the ACA was enacted, it seems mildly prophetic in a lot of ways in showing how a continuation of a broken system can only continue to be broken.
I think my favorite part of the book is that it doesn't heavily lean into the idea that America should be like Norway or Finland. It surprised me to learn those systems are also heavily problematic in terms of controlling cost. Rather, a more interesting example forward for America is Singapore, of all places.
By the end of the book, we're treated to a comprehensive assessment of how to fix a system that waylays itself with profligate actors that have no incentive to change. In the next 5 years, we're likely to see a collapse in Medicare expenditures in a similar fashion to what happened with the housing industry. Goldhill's solution is elegant and pragmatic, in my opinion. He prescribes a three-pronged system that simultaneously moves incentives for insurers to only truly insure against catastrophic events, for marketplace consumers to save their own money and demand cost-effective care at a basic level and to do all this while managing to either spend the same amount of money we're currently pouring into a broken system or to even save money while doing it.
Infections from a hospital stay killed David Goldhill's father in 2007, one of more than 200,000 deaths annually caused by medical error. The medical bill was huge and fully paid by Medicare. David wanted to know why it happened and why a business was paid after such a colossal error. This would not happen in a market driven business. This book is the result of Mr. Goldhill's quest for answers.
The major premise of Mr. Goldhill's book is that the patient is not the customer. The actual customers are what he calls "surrogates" and these are private insurers, Medicare and Medicaid. All of these are institutions begun with the best of intentions that have grown into unwieldy, inefficient behemoths over the last 45 years and have established a culture in our Health Care arena that is going to be difficult to change.
Originally, health insurance was in place to take care of "catastrophes" and not the common cold or the equivalent. We have turned an insurance into a "payment mechanism" over the years.
The "surrogates" have become the consumers and are driving the market. They are profit driven, not market driven and have created a 3rd party administration that continues to drive up the price of health care and not, necessarily the efficiencies. The "Surrogates" along with the pharmaceuticals operate with a unique set of rules and, ironically, the higher premiums are, the higher the profits.
In a true market scenario, prices drop and things become better and/or more efficient. The most obvious analogy is computers. The first laptops were thousands of dollars; you can now buy a better one for about $350.00. Lasik surgery and most cosmetic surgeries prices drop because of competition. Why? They are not covered by insurance, thus no surrogates.
We, as the patients, have come to accept the status quo. We go crazy when a gallon of gas rises by 10 cents, however, just accept the fact that medical procedures continue to escalate because the surrogates are in control and we are just paying the deductibles. The surrogates benefit from rising prices.
So, what about the Affordable Care Act [Obamacare or ACA]? More of the same. We need to create a new system that is not procedure driven, is a true marketplace and is driven by the true customer, the patient. This will take a minimum of a generation; however, it can be done.
Mr. Goldhill presents a possible scenario that places the patient in control and promotes transparency in costs in the medical field. His suggestion is a combination of a very high deductible in true catastrophic insurance, health accounts and health loans. I am not sure if that is the answer, but he presents a convincing argument and makes it very clear that the present situation in health care is unsustainable.
My suggestion is that you read this well-written and well researched book and get your legislators to do the same. Thanks to Mr. Goldhill for presenting such a well articulated case in a tremendously complex situation.