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Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It, by David Goldhill
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From Booklist
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
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Review
"David Goldhill has written a devastating and utterly original analysis of what has gone wrong with the American health care system. Read it, and take a deep breath. He will convince you that our ‘solutions’ are not solving our problems. They are making our problems worse."—Malcolm Gladwell"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, best-selling 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." —Publishers Weekly (starred review)"[Catastrophic Care] is 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 "Highly readable presentation of one businessman’s solution, likely to provoke discussion if not agreement." —Kirkus Reviews “Rarely has the irrationality of the [healthcare] system been so convincingly demonstrated, including the opaque and highly inflated prices of medical care.”—Arnold Relman, The New York Review of Books"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 . . . As an industry outsider—neither a clinician, policymaker, or someone who works for the healthcare industry—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"[A] comprehensive, thought-provoking, empirical, and well-written book."—Matthew Continetti, The Weekly Standard"Provacative."—Wayne Holliday, Decatur Daily“Goldhill’s perspective is invaluable to the health-care discussion, elevating his personal tragedy into an impressive body of research. Written with both pain and passion, this book provides an informative and relatable treatise.”—Elizabeth J. Eastwood, Library Journal"Innovative . . . Goldhill presents a convincing argument in many ways, and this book already has challenged policymakers to examine his proposals.” —William P. Moran, Charleston (SC)Post and Courier“David Goldhill isn’t your typical policy expert. He is the chief executive officer of GSN. That’s right, the Game Show Network. What does he know about health care? Quite a bit, it turns out.”—Chelsea Conaboy, Boston Globe, White Coat Notes
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Product details
Hardcover: 384 pages
Publisher: Knopf; 1 edition (January 8, 2013)
Language: English
ISBN-10: 0307961540
ISBN-13: 978-0307961549
Product Dimensions:
5.2 x 1.3 x 7.8 inches
Shipping Weight: 12 ounces (View shipping rates and policies)
Average Customer Review:
4.4 out of 5 stars
111 customer reviews
Amazon Best Sellers Rank:
#532,480 in Books (See Top 100 in Books)
This book should be required reading for anyone who's ever wondered, "well, what exactly is so bad about our healthcare system?" In this fascinating read, David Goldhill approaches the matter of care from the lens of a business person, which I can wholly appreciate. The problems we face in healthcare today, he contends, are primarily a result of a broken marketplace for healthcare. We are not consumers in this system, we are pawns for powerful surrogates to extract profit from.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.
By profession, I think and talk about health care quite a bit. Sure, it's insanely expensive; sure, it's dangerous; sure, it's appallingly inaccessible, even to people with money and time to spend trying to figure out out. But until I read this book, it didn't occur to me to question the underlying principle of our health system--namely, that insurers of various kinds (private companies, government agencies) are naturally and necessarily interposed between human beings and medical care. This book exposed that principle as a historical accident -- and the health system it sustains as a perfect machine for producing human misery and economic devastation. In making that argument, this book changed my mind about single-payer health insurance (I no longer think it'll help), about the utility of market forces (I now think they matter), and even housing policy (!). This book should be required reading for anyone in healthcare or health policy, and it would help anyone with a human body who anticipates needing medical attention at some point. Brilliant.
If you start your career at age 22 in a $35K job, work until age 65 with a 4% bump each year, you will have earned about $3.85 million over those years.Guess how much of that you will have paid into the healthcare system -- through Medicare and Medicaid taxes, through your share of premiums, out-of-pocket, co-pays, and the portion of your compensation that your employer pays in health insurance premiums.$1.9 million -- assuming that, miraculously, the costs of healthcare and health insurance suddenly stabilized to keep pace with the CPI instead of beating by 150 to 200 percent a year as it does now.David Goldhill takes a deep, deep dive into the way our healthcare system works. Or doesn't, as a nation with the best medical technology and (arguably) the most talented medical personnel has outcomes that are middling at best.He explains why our current financial model for healthcare is unsustainable (obviously, since it eats half our incomes). But he also explains why "Medicare for all" or any third-party pay system will never control costs.This book is a must-read for anyone involved in making healthcare policy. And for anyone who'd like to find a way to not pay half his or her income for healthcare insurance and services. And, yes, it offers a realistic, tested and proven solution -- an example in which superior outcomes are provided at significantly lower cost in a nation whose demographics closely reflect our own.
I’ve worked in healthcare administration for the past 5 years, during which I’ve read many takes on the issues plaguing our health system. As someone who came into healthcare from outside industries, I love my work but have often been stunned by levels of inefficiency and dysfunction that would never be tolerated in any other sector. I’ve never read anything, however, that makes full sense of what I’ve experienced....until now, that is. Goldhill breaks down the root cases of our system’s problems in a way that almost anyone can understand. And his solutions? Jarringly simple, yet logically sound. Brilliant stuff.
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September 14, 2013
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