Catastrophic care
"A visionary and completely original investigation that will change the way we think about health care: how and why it is failing, why expanding insurance coverage will only make things worse, and how it can be transformed into a transparent, affordable, successful system. In 2007, David Goldhill's father died from a series of infections acquired in a well-regarded New York hospital. The bill was for several hundred thousand dollars--and Medicare paid it. These circumstances left Goldhill angry and determined to understand how it was possible that world-class technology and well-trained personnel could result in such simple, inexcusable carelessness--and how a business that failed so miserably could be rewarded with full payment. Catastrophic Care is the eye-opening result. Goldhill explicates a health-care system that now costs nearly $2.5 trillion annually, bars many from treatment, provides inconsistent quality of care, offers negligible customer service, and in which an estimated 200,000 Americans die each year from errors. Above all, he exposes the fundamental fallacy of our entire system--that Medicare and insurance coverage make care cheaper and improve our health--and suggests a comprehensive new approach that could produce better results at more acceptable costs immediately by giving us, the patients, a real role in the process.
Stats for nerds
7recommend
12mentions
8people
2013–2019years
83% recommend17% neutral
Mentions per year
What Hacker News says
- >“People will say to me, ‘Why are MTA construction costs so high?’ And the answer is ‘Everything,’ ” says Julia Vitullo-Martin, a senior fellow at the RPA and co-author of its 2018 report comparing New York’s construction costs to those in peer cities. “Every factor you look at is flawed the way the MTA does business, from the first step to the end.”
>When you’re doing everything wrong, the best way to fix the problem isn’t usually to go through the list of things you’re doing wrong and fix them one by one. It’s best to step back and ask why you’re so bad at everything, whether a systemic problem is causing you to make so many separate mistakes. And in the case of the MTA, the root cause of its capital-construction failures is usually diagnosed as unaccountability: Nobody knows who’s in charge, so nobody has to be terrified of taking the blame for obscene costs and endless delays.
This is very similar to the explanation for the American healthcare system's turmoil given by David Goldhill (founder of https://sesamecare.com/) in his book Catastrophic Care. Even for those that disagree with his recommendations, he delivers a great analysis of the perverse incentives that gave rise to the broken healthcare system.
- The potential benefit of having checklists is enormous, and people's lives are on the line.
Many people rightfully ask
> Why has this not been adopted everywhere _yesterday_?
A book I read a few years ago might have the answer.
_Catastrophic Care: How American Health Care Killed My Father—and How We Can Fix It _ [0]
Here's the description, to evaluate if you want to give it a read:
> In 2007, David Goldhill's father died from a series of infections acquired in a well-regarded New York hospital. The bill was for several hundred thousand dollars--and Medicare paid it.
> These circumstances left Goldhill angry and determined to understand how it was possible that world-class technology and well-trained personnel could result in such simple, inexcusable carelessness--and how a business that failed so miserably could be rewarded with full payment.
> Catastrophic Care is the eye-opening result.
> Goldhill explicates a health-care system that now costs nearly $2.5 trillion annually, bars many from treatment, provides inconsistent quality of care, offers negligible customer service, and in which an estimated 200,000 Americans die each year from errors. Above all, he exposes the fundamental fallacy of our entire system--that Medicare and insurance coverage make care cheaper and improve our health--and suggests a comprehensive new approach that could produce better results at more acceptable costs immediately by giving us, the patients, a real role in the process.
[0] https://www.goodreads.com/book/show/13642523-catastrophic-ca...
edit: formatting
- The cost per employee for benefits is definitely a key reason why full time / full benefits wages have stayed relatively level. It's been hidden as well since folks don't normally understand how much their employer has to pay for their benefits. The book Catastrophic Care by Goldhill has a good take on this in my opinion.
That said - there is a reason to be optimistic about all of this. If this demand pressures pushes to increase wages it might provide enough of an incentive to create room for real reform here, as well as transparency around what is happening with benefits that could spur longer-term cost control fixes.
- Yep. There's a book that does a good job outlining the main problems in the healthcare industry: "Catastrophic Care" by David Goldhill.
https://www.amazon.com/dp/034580273X/ref=cm_sw_r_tw_dp_U_x_-...
The big issue, as you mention, is health insurance companies themselves. They aren't actual insurance companies—they are payers, like others in this thread have called out. Real insurance exists when unlikely but disastrous events occur, like a house fire or a car accident.
Payers act more like surrogates—they bargain and make purchasing decisions on behalf of users like us. This is the fundamental problem in healthcare because surrogates cannot make financial decisions as well as a free market can.
Goldhill’s proposal for changing the industry is to eliminate the role of surrogates and replace it with a version of a health savings account that everybody would be required to contribute into and carry indefinitely, and require everybody to have a very high deductible catastrophic insurance plan. For example, all healthcare payments under $30k would be paid for directly by the patient and come out of the savings account. When something truly big and expensive occurs in a patient’s health (e.g., a cancer diagnosis) is when catastrophic health insurance would kick in and cover it.
This would allow for patients to make active decisions about which type of care to choose, and would force providers to become more competitive to earn the business of actual customers.
- This concept is addressed in the book “Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It.”
Highly recommend it. It’s got some great ideas. And I've mostly just copy/pasted this from another comment I made recently. I really hope some of the ideas in that book start making inroads via legislation.
- If you are interested in the various failures of the American health care system, I recommend reading Catastrophic Care by David Goldhill. It's a bit depressing, but eye-opening.
