How American Healthcare Killed My Father: Q&A with David Goldhill

 

David Goldhill is the head of the Game Show Network - and one of the most-lucid analysts and unforgiving critics of the American health care system.

In this interview, produced by Reason TV's Jim Esptein and conducted by Kmele Foster, Goldhill talks about his must-read new book, Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It, what's wrong with Obamacare, and much more. If you care about the future of medicine and insurance in this country, watch this interview.

Released on Friday, November 1. Read the original writeup and get more info by clicking below.

In 2007, David Goldhill's father was admitted to a New York City hospital with pneumonia, and 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 is currently the CEO of the Game Show Network. "But," as Goldhill recounts,

A month later there was a profile in The New Yorker of physician 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, but he was having a hard time getting hospitals to sign up for this. I had helped run a movie chain, 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 got interested in the economics of the American health care system. In 2009, he published a much-discussed article in The Atlantic, which he has now expanded into a book, titled Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It.

Goldhill argues that the major problem in health care is a system of incentives that puts most of the purchasing power in the hands of insurance companies and the government, while cutting patients out of the equation. This system isn't just costing us a lot of money, it's killing us. As Goldhill explains, there's a direct link 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 hospital.

Reason TV Contributor Kmele Foster sat down with Goldhill to discuss the problems in our health care system and why turning patients back into customers will go a long way towards solving them.

Produced, shot, and edited by Jim Epstein. Additional camera by Anthony Fisher.

About 30 minutes.

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  • Anvil||

    The problem with healthcare starts with our govt., it's regulations, and how insurance companies have expanded as a result of lobbying politicians.

  • BakedPenguin||

    This is a long video, but it's pretty good. Goldhill is pretty articulate about the problems of government healthcare, and Foster asks the right questions.

  • Voros McCracken||

    I agree I think this one of the best videos of this type Reason has done.

  • STL Sully||

    I found it very insightful. I only wish more individuals understood why markets forces drive prices down and government intervention drives them up. Ironically, we can assign the ignorance to government run schools. Again, the absence of competition creating crappy results on display.

  • JeremyR||

    But government regulation of the medical industry is necessary.

    You can't have a free market it in medicine.

    You have to license doctors, nurses, etc. You can't just let anyone perform surgery. You have to control drugs - I'm not talking about ones meant for recreational use, but medical drugs. Overuse of some (like antibiotics) can cause major problems.

    Governments do have some reason for existing, and medicine is one of them.

  • Dweebston||

    It's not like government licensing eliminates malpractice or criminal negligence, or does much more than private certification coupled with the omnipresent threat of civil liability. It does, however, suppress the number of doctors or specialists.

    I'm not yet sure how to address the problem of antibiotics, which is a peculiar sort of commons, but it should be noted that we have issues with resistant pathogens despite some modicum of government control. You might say it would be worse without the bureaucratic restraints in place, but you can't claim it's the optimal solution.

  • Dweebston||

    I should also note the artificial and largely arbitrary segregation of practitioners under the bureaucratic model, which dictates what relatively innocuous procedures certain personnel may do that other trained providers cannot. Very much like the strict and terrifyingly actionable divisions in unionized labor pools.

  • John C. Randolph||

    government regulation of the medical industry is necessary.

    No, it's not. Tort law is quite sufficient.

    -jcr

  • C. Anacreon||

    Tort law is quite sufficient.

    Exactly. After you paid a person who had absolutely no knowledge of what he was doing to treat you in a laissez faire medical system, and you went blind and couldn't walk as a result, why the several years in court hoping for a payoff would be more than worth it.

    There do have to be certain standards for medical practitioners. Perhaps private certification would be best, but it would be a crappy world where anyone who wanted to could call themselves doctor with no ramifications other than tort law. Would you have to rely on "Yelp" to know if they were qualified? Would you trust a diploma on the wall? Would you have the time or resources yourself to track down all the training of your doctor to make sure those sheepskins weren't just created on his computer?

    And it would take quite a long period of screwups before enough torts brought someone down, during which you could be that quack's victim.

    The vast majority of licensing is an exclusionary scam (eg dog walkers). But some professions need to have a certain amount of verifiable accreditation. The potential bad outcomes of an untrained physician are far too serious -- it's not like suing your contractor for a leaky roof.

  • ||

    "Exactly. After you paid a person who had absolutely no knowledge of what he was doing to treat you in a laissez faire medical system, and you went blind and couldn't walk as a result, why the several years in court hoping for a payoff would be more than worth it."

    In a Laissez Faire medical system, you didn't ask for credentials and just took their word for it? Wow what a moron you are.

  • RickC||

    You do know that about 90,000 people die every year in the U.S. from medical mistakes and hospital acquired infections? As the video makes clear, the second problem could be eased through very simple changes. The first problem reminds me of the joke, "What do you call the person who graduated from medical school dead last in his class? Doctor."

  • Adam330||

    Right, because the state licensing system totally stops fake doctors from peddling their services:
    http://www.nbcnews.com/id/40630166/

  • ||

    "But government regulation of the automotive industry is necessary.

    You can't have a free market it in cars.

    You have to license engineers, mechanics, etc. You can't just let anyone perform maintenance. You have to control parts - I'm not talking about ones meant for recreational use, but after-market parts. Overuse of some (like performance enhancements) can cause major problems.

    Governments do have some reason for existing, and cars is one of them.

    Etc..

  • ||

    " Overuse of some (like antibiotics) can cause major problems."

    WTF? Who the fuck are you to decide that antibiotics are being overused?

    Are you trying to claim that governments have a responsibility to dole out effective treatments to a chosen few? Antibiotics aren't a fucking right. If you contract an infectious disease without a viable antibiotic treatment, who's fault is that? If the government's job to allocate treatment, why are they relying on private businesses to develop them?
    In a world of government-regulated medicine, doctors are probably scared shitless of NOT prescribing antibiotics for fear of malpractice suits. Absent the regulatory burden, you might actually see the shelf-life of these medicines increased.

  • C. Anacreon||

    Before you rant too much, look up the subject of treatment-resistant infections and hope that in your lifetime there does not come a plague that exceeds our ability to stop it, because antibiotics have been handed out so willy-nilly.

    Unfortunately, the overuse of antibiotics is not one area where government is to blame. Docs hand them out inappropriately (and uselessly) to anyone coming in with the sniffles because people want to believe they are getting treated. And in most other countries, you can just buy most antibiotics off the shelf at the corner store, and pop them like breath mints.

    Do you have any idea why penicillin, the great antibiotic which was just introduced in the last 75 years, is already almost useless?

  • ||

    And? Bacteria evolves. It's part of life. Get over it.

    Unfortunately, the overuse of antibiotics is not one area where government is to blame. Docs hand them out inappropriately (and uselessly) to anyone coming in with the sniffles because people want to believe they are getting treated.

    As I stated, so fucking what? You're entitled to effective antibiotics? You're entitled to not get infected with antibiotic-resistant bugs? Fuck off.

  • ||

    "Do you have any idea why penicillin, the great antibiotic which was just introduced in the last 75 years, is already almost useless?"

    Do you have any idea what sero-types became recessive as a result of said over-prescription of penicillin? No? Fuck off.

  • IDPNDNT||

    I think the scary thing as someone who works in health care is that doctors and surgeons are by far the least likeliest to wash their hands.

  • JWatts||

    Why the photo of Obama?

  • Free Society||

    could be the massively uninformed health industry interventions on behalf of obama.

  • JeremyR||

    The problem with books like this is we can see health care in countries like Canada and Europe, which somehow manage to both cost much less.

    It's impossible to have a free market in health care. The government has to regulate it. As it is, we already over prescribe antibiotics. Imagine what it would be like if anyone could buy them?

    But yes, the current system is terrible. My mother had health problems, and despite having pretty good insurance, the hospitals treated her terribly. Evicting her 2 days after her heart operation when she couldn't even stand up. Later when she had cancer, the hospital let her get bed sores. And this was one of the supposedly "best" hospitals in the region. God only knows how awful the average or bad ones are.

    And yet, our health care costs more than any other country in the world. Not even close. And Obamacare is going to make it go up even more. We have to start over from scratch.

  • Dweebston||

    You act as though government imposing rules is a form of sane, sound, informed regulation, or that sane, sound, informed regulation wouldn't exist absent government. I agree: healthcare requires regulations. But I have more faith in consumer-driven, competition-enforced market regulation with recourse to insurers and the courts than I do bureaucrats like those empowered by the ACA deciding from afar how to contrive a safe, effective, and efficient environment.

  • NotAnotherSkippy||

    Our healthcare costs more because we use more. We also subsidize the world when it comes to medical devices and new drugs because we have one of the few, if not only, free markets in those areas. The reality is that your precious single payer systems like Canada and the NHS do kill grandma. They do so by limiting care, particularly in the end stages of life. Now that is a legitimate policy discussion to have, but you have to realize that our healthcare costs more because our government is much more generous than our peers.

  • Paul.||

    Serious question:

    Why would "everyone get antibiotics" if they had to pay for them.

    The reason "everyone gets antibiotics" NOW, is because there's no price signal to the consumer. Your insurance pays for it, or it's free for you because you're on medicaid.

  • JW||

    The reason "everyone gets antibiotics" NOW, is because there's no price signal to the consumer. Your insurance pays for it, or it's free for you because you're on medicaid.

    Bingo.

    The 3rd party payment system, which insulates the patient/customer from the dollar costs of their medical decisions, is one of the most pernicious reasons that the US medical system is so out of whack, price-wise, compared to the rest of the world. The socialized medicine countries only look good in comparison due to their price controls and actual and real rationing.

    As fucked as the US system is from the gubmint meddling, it's still the one that people seek out for treatment, when time and/or quality matters.

  • Charlotte Falcon||

    He explains this at the very beginning: healthcare does not equal health. The link is tenuous at best. The real drivers of health are diet, behavior, lack of stress, etc. The nations of the western world have much the same life-expectancy regardless of how much they spend on healthcare.

    Watch the interview.

  • JidaKida||

    Sounds like some serious business to me dude.

    www.PrivacyRoad.tk

  • Agoraphobic||

    I was way ahead of the curve on this one...

    Oxford NJ cancelled my low-premium/basic plan back in 2010(!) "in anticipation of the implementation of the ACA" (don't recall the exact wording in the cancellation notice, but it was to that effect). I immediately thought back to the time I heard Barry say I could keep my plan if I liked it, but then I reasoned that maybe I wasn't keeping it because I didn't really like it.

  • Jackand Ace||

    Goldhill says this in the Atlanic article:

    "First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be REQUIRED to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives."

    Sounds a bit like a single payer system to me, and IS an individual mandate.

  • Jackand Ace||

    Oh, and he also says this:

    "For lower-income Americans who can’t fund all of their catastrophic premiums or minimum HSA contributions, the government should fill the gap—in some cases, providing all the funding."

    This is your guy, Nick?

  • ||

    Look up the word "catastrophic" and restate your position. There will be a test later.

    CB

  • ||

    Mandatory catastrophic addresses the easier issue of simply having coverage. But the complication is not in the coverage itself. The complication is in the amount. How much should society spend in dealing with edge cases and dealing with end of life? It can't be unlimited, which is the general expectation now. Upthread, NotAnotherSkippy mentioned "killing grandma". Is that really a bad thing? Or is it simply a tough choice, made tougher when it's politicized.

    A simple cap to catastrophic coverage is not the solution either. Providers will charge up to the cap, regardless of whether the charges are necessary or advisable. The only real solution involves cost control incentives where there are cost/benefit decisions made by the patient/family. Which means there needs to be incentives to not take unlimited care.

    But that still leads to less than adequate outcomes ('come on Grandma, sign the paper, then we'll pull the plug, collect 50K, and you can rest').

    There are no easy solutions. But the present state, focusing only on benefits and not costs, is fairly close to being the worst possible.

  • JW||

    There are no easy solutions. But the present state, focusing only on benefits and not costs, is fairly close to being the worst possible.

    And removing choice from the formula, on top of everything else, *is* the worst possible.

  • Jackand Ace||

    Test away, mon frère...no need to restate my position at all.

    So tell me, you agree with Nick and Goldhill that there should be a single payer system, even if it is only limited to catastrophic events, and that there should be an individual mandate to do so, and that the government should provide all the funding for those who can't afford the premiums?

    C'mon, boy, don't fail your test on what it means to be a libertarian.

  • Meerkatx||

    I've worked for hospital for 20 years.

    I can tell you exactly why things are not cleaned up or disinfected in a timely manner, as well as not done as well as possible.

    When hospitals want to save money they cut the non nursing staff and nursing aids. Janitorial, warehouse, cafeteria, engineering, transportation staff, CNA's are laid off while human resources, managers and there are many many managers and supervisors are all kept at full staffing levels.

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