In 2007 David Goldhill's father was admitted to a New York City hospital with pneumonia. Five weeks later, he died there from multiple hospital-acquired infections. "I probably would have been like any other family member dealing with the grief and disbelief," says Goldhill, a self-described liberal Democrat who now serves as CEO of the Game Show Network.
But then Goldhill read a profile of a physician named Peter Provonost, "who was running around the country with fairly simple steps for cleanliness and hygiene that could significantly reduce the hospital-acquired infection rate." Provonost had been having a hard time bringing hospitals aboard, which the TV executive found surprising.
"I had helped run a movie chain," Goldhill says, "and we had a rule that if a soda spilled, it had to be cleaned up in five minutes or someone got in trouble. And I thought to myself, if we can do that to get you not to go to the theater across the street, why are hospitals having such a hard time doing simple, cost-free things to save lives?"
That's how Goldhill first became interested in the economics of the American health care system. In 2009 he published a much-discussed feature story on the subject in The Atlantic under the provocative headline "How American Health Care Killed My Father." He has now expanded that article into a book.
In Catastrophic Care (Knopf), Goldhill decries a system of incentives that puts most health care purchasing power in the hands of insurance companies and bureaucrats, while cutting patients out of the equation. There's a direct link, he argues, between the way we pay for health care and the estimated 100,000 patients in the U.S. who die every year from infections they picked up in the hospital.
Reason TV contributor Kmele Foster sat down with Goldhill in October to discuss how turning patients into customers would go a long way toward solving the problems of American health care. An edited transcript of their conversation follows. For a video version of the interview, go here.
reason: In your book, the word incentives comes up a great deal.
David Goldhill: The fundamental argument I make is that removing us as the real consumer in health care and putting someone between us and providers-whether it's insurers, whether it's Medicare or Medicaid-has completely turned the incentives in the system on their head. What we see now is that the best way to make money in health care is to price high; provide excess service; be sloppy about safety; underinvest in service, which includes information technology; and lack the type of accountability we see in anything else.
reason: How did health care and health become synonymous?
Goldhill: You'll hear, "The United States spends so much on health care and lags behind other countries in health measurements." Well, we don't really measure the outcomes of health care. We measure how long we live, how vigorous we are through old age, how many of our children are born healthy. We measure those types of big things. Unfortunately, all of them have almost nothing to do with health care. The things that drive health are all lifestyle. Nutrition, exercise, stress, income, education, public safety-all of these things drive health results far more than health care.
The most dangerous thing we do in health care policy is we imply that making sure that everyone has the maximum amount of health care is essential to health, when one could better argue that diverting 18 percent of our GDP into health care has made us significantly less healthy as a country. I always like to turn that little thing on its head and say, "You know what's amazing? No developed country's health seems to suffer, no matter how little it spends on health care." It may be the least important factor in health, and yet it's the one we emphasize.
From there a lot of things go wrong. From there, we have a system where much of the debate is about money: How do we pay for all the health care people? And we miss a big question: If we pay for health care in such a way that we take the individual out, are we going to subject people to excess care and excess treatment, which is a major cause of harm and injury and poor health in itself?
reason: There seems to be a real desire on the part of many Americans to not think about their health care costs.
Goldhill: The foundation of health care economics in this country is an article written by Kenneth Arrow. He said that health care can never be a normal industry, because you'll buy whatever your doctor sells you. He's got all the expertise. You're desperate, you're sick, he's gonna tell you how not to be sick. You'll buy anything. There can't be any normal marketplace transaction.
So now we never ask them what it costs, and we buy everything. It's almost what I would call Arrow's revenge, although I don't think he would take that very kindly.