Thursday, May 30, 2013
CATASTROPHIC CARE: HOW AMERICAN HEALTH CARE KILLED MY FATHER--AND HOW WE CAN FIX IT by David Goldhill
I am so glad we are going on Medicare in August.
Medicare isn't perfect, by any means. It isn't even cheap. Just the insurance (Medicare medical, Medicare supplement, prescription) is going to cost us more than $500 a month, and that doesn't include the deductible or the prescription co-pays. And that's for this year. Who knows what it will cost 10 years from now?
I was so ready to read a book that would solve America's health-care crisis.
Besides, David Goldhill's title is irresistible: Catastrophic Care: How American Health Care Killed My Father - And How We Can Fix It.
First the bad news. Goldhill, who is president and CEO of the Game Show Network, got interested in health care when his physician father "died from a hospital-borne infection he acquired in the intensive care unit of a well-regarded New York hospital." In his early chapters, he piles up statistics about how truly dreadful our health-care system is. Wherever you are on the political spectrum, you need to read his "eleven strange things we all believe about health care." (Goldhill is a Democrat who thinks Obamacare will not work.)
After the bad news, Goldhill gives all kinds of wonky explanations about why our approach to health care doesn't work. This section will probably appeal most to free-market-loving Republicans. Despite being a lefty who distrusts the market, I found it very helpful.
Finally what we're all waiting for: Goldhill's solution. My daughter Molly should have written this book: she recommended an almost identical solution to me a couple of months ago when we had a long discussion about health care. (Molly and I do not agree about a lot of political issues, but we have respectful and helpful discussions. We don't see the point in today's political polarization: differing opinions can increase clarity and come up with better solutions than either side could do on its own.)
In a nutshell: Insurance should be reserved for catastrophes - unforeseen big-ticket expenses like major surgery or cancer treatment. Anticipated health-care expenses should come from health-care savings accounts. And there needs to be some kind of safety net.
What Republicans will like: Consumers need to have control of their own health-care dollars. There's no reason to siphon off 20% or more to insurance companies. Besides, when we pay for things ourselves, we tend to be a lot more careful about what we buy. We comparison shop. We avoid unnecessary expenses. And to get our money, providers compete with one another to provide good care at low prices.
What Democrats will like: Everyone must have a health-care savings account - no exceptions. Most people will build up a good-sized balance when they are young. As they age, they will start to draw from it. People whose emergencies cost more than their savings can borrow to cover the additional expenses. At a predetermined level, they need borrow no more: the government will make up the difference. Nobody will be left without health care: the government will provide the safety net (though not by running the program).
What everyone except certain industries and lobbyists will like: Prices must be completely transparent and equal for everybody. The market isn't free if people don't have the information they need to make smart decisions.
What nobody will like: There will be limits. Just because something sounds good in the TV ads doesn't mean everyone should have access to it. Some treatments (especially those that have little proven worth in lengthening lives) will not be available. Some will be too expensive and most people will choose to forgo them. Some will be available, but only to people who have lots of money to spend.
My favorite health-care book is still T.R Reid's The Healing of America. (See my review on this blog or in Christian Century, if you subscribe.) The fact is that a lot of other developed nations have much better health-care programs than America's. They get better results. People live longer. And they do this for about half our cost. Before we do anything else about health care, we need to lay aside our prejudices and study what these other countries are doing.
But if Reid should be required reading for legislators, Goldhill should be too. As Goldhill points out, America's politicians are unlikely to accept a lot of features that make perfect sense in other countries. We need a program that fits with our own weird beliefs and behaviors--one that combines vigorous free-market competition with a safety net for everybody.
Someday we may actually come up with such a program. But probably not until we understand, as Goldhill says, that "at some point, we will have to decide whether our attachment to the idea of helping people is more important than actually helping them--a decision that will require a rethinking of our assumptions."