David Goldhill’s father died from an infection he contracted in a well-regarded New York hospital.
That began a quest to investigate America’s health care system. In his book “Catastrophic Care: How American Health Care Killed My Father and How We can Fix It,” Goldhill reports that nearly 100,000 Americans die every year from hospital-borne infections.
That’s more than double the number of Americans killed in car crashes and five times the number of those murdered.
How did American hospitals miss the quality control revolution that affected the rest of the American economy?
Goldhill contends that our current system drives “excess treatment, cost inflation and medical errors.” And he says the Affordable Care Act only worsens the perverse incentives and would raise the cost of care.
He worries that the exchanges will reduce competition among insurers, the subsidies will make consumers less price-conscious and mandates will cause healthy people to drop insurance.
The result may be less coverage at higher costs than the authors of the Affordable Care Act intended. He describes the health care system as “the Beast” that tolerates excess and careless medicine.
“Bad health care is crowding out needed care,” he writes.
His solution is to combine the liberal desire for universal health care with a conservative desire for market-oriented approaches.
He calls for a national insurance safety net that covers health crises that are “major, rare and unpredictable.”
“Insuring everyone isn’t the same as insuring everything,” he writes.
That means using insurance as it was meant to be used, for rare catastrophic events.
What the health care system does disastrously is provide quality care at affordable prices. In 2009, Medicare had $54 billion in proper payments.
Goldhill’s plan involves health savings accounts, health loans and catastrophic insurance.
- Increase money we put into health care and save the difference.
- Reduce the use of unnecessary health care to some people so others may build savings.
- Cut spending in ways that don’t hurt quality and transfer that into savings.
Money currently put into the health system would accumulate in a tax-free account. That money would be used to pay premiums for cradle-to-grave health insurance.
If you run out of money, you can borrow against your future contributions. While it doesn’t sound practical in today’s political system, the ideas are based on an interesting set of principles. His plan is basically along the same lines as Singapore’s national system.
“We’re stuck in a vicious cycle in health care. The more we try to protect ourselves from the realities of care, the more complex and unconnected from us the system becomes,” he wrote. It’s far too complicated for the average person.