David Goldhill’s thought provoking examination of the U.S. health care industry is informed by his keen business perspective. It is through that lens that he compares health care functions and outcomes to other industries’ expectations. Further, he proclaims that all Americans have the same expectation, which is affordable, high-quality health care for everyone.
Hold the phone. A for-profit business executive who actually states that better than adequate health care should be available to all people in the country? That alone should be enough to provoke your interest.
As an industry outsider—neither a clinician, policymaker, or someone who works for the health care industry—Mr. Goldhill observes and explains the issues in an understandable manner for the layperson. Mr. Goldhill’s take on the Affordable Care Act is filled with blithely ironic observations, such as the profit taking by the “rapacious” drug companies at the expense of the public or the employees who contribute to the cost of their health care plan are actually paying for the cost of this “employer-provided” benefit.
For those who skipped economics in college, read Chapter 3, a great explanation of basic economic principles explaining how health care delivery skews in favor of the insurers. For example, the only way for the health insurance industry to make more money is to increase premiums, which isn’t necessarily related to improvement of services.
Just as Medicare and Medicaid lack incentives to reduce the size of our national health care costs, every time caps on Medicare services have been suggested to the legislature, they capitulate.
Without getting too wonkish, there are adverse incentives, called moral hazards, that are supposed to control costs permeating the health care system.
Refreshingly, Mr. Goldhill calls for increased transparency in health care services both for pricing and patient safety. Though the Accountable Care Act does mandate more reporting of clinical outcomes, medical supplier pricing, and even insurance company utilization of premium payments, he shows how transparency would impact a health care consumer’s decision.
Basically Mr. Goldhill is calling for us all to get more skin in the game in terms of disclosure, payment, and negotiating for services. If hospitals were required to post their patient safety scores that alone would help create a level playing field for consumers. Americans currently rely on others to assure their safety, but clearly this method has not proven effective—for us, that is.
Mr. Goldhill’s chapter titled The Fallacy asserts that more drugs and tests do not mean better health, but do mean higher profits for drug companies, clinicians, and medical suppliers.
Lest you think the book is dull, the author’s sage comments on the branding of Viagra as a medicine as opposed to a sexual aid for “the rare night of romantic failure” are spot on.
With his beloved father as the base case study, Mr. Goldhill reveals how absurd some of the Medicare policies are regarding payment of services. He takes us through end-of-life-care and the impact on the elderly. For example, Medicare pays for prostate cancer screenings or mammograms for someone who is terminally ill, but will often not pay for more directly helpful treatments.
But the valiant award goes to Mr. Goldhill for revealing the inequities in hospital billing, which impact what we all pay in the end. You’ve got to have game when you take on the hospitals, because they are big business in this country.
Though at times Catastrophic Care is pedantic and hard to read, it is a worthy eye-opener for anyone shelling out money for health care (i.e. everyone). Mr. Goldhill even clearly explains an alternative plan for providing health care financing and creating consumer incentives to better manage health and health care purchasing—a far cry from the practical advice most books about health care don’t provide.
David Goldhill is a board member of the patient safety watchdog, The LeapFrog Group, so his ideas carry weight. He postulates that we may actually improve our health by putting our health care spending on a diet through more consumer involvement in health care decision making.
I’ll drink to that.