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Catastrophic Care: How American Health Care Killed My Father - and How We Can Fix It
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Audible Audiobook
Listening Length: 13 hours and 1 minute
Program Type: Audiobook
Version: Unabridged
Publisher: Random House Audio
Audible.com Release Date: January 8, 2013
Language: English, English
ASIN: B00AMNOFM4
Amazon Best Sellers Rank:
This book should be required reading for anyone who's ever wondered, "well, what exactly is so bad about our healthcare system?" In this fascinating read, David Goldhill approaches the matter of care from the lens of a business person, which I can wholly appreciate. The problems we face in healthcare today, he contends, are primarily a result of a broken marketplace for healthcare. We are not consumers in this system, we are pawns for powerful surrogates to extract profit from.Goldhill takes us on a whirlwind tour of almost literally every facet of care I've never even thought about, from Medicare and Medicaid to the broken rewards systems that are powering the next generation of physicians. Overall, I felt the analysis was incredibly well done and well researched, little was left to the imagination as to why and where our system has failed us, and even though the book itself seems to have come out before the ACA was enacted, it seems mildly prophetic in a lot of ways in showing how a continuation of a broken system can only continue to be broken.I think my favorite part of the book is that it doesn't heavily lean into the idea that America should be like Norway or Finland. It surprised me to learn those systems are also heavily problematic in terms of controlling cost. Rather, a more interesting example forward for America is Singapore, of all places.By the end of the book, we're treated to a comprehensive assessment of how to fix a system that waylays itself with profligate actors that have no incentive to change. In the next 5 years, we're likely to see a collapse in Medicare expenditures in a similar fashion to what happened with the housing industry. Goldhill's solution is elegant and pragmatic, in my opinion. He prescribes a three-pronged system that simultaneously moves incentives for insurers to only truly insure against catastrophic events, for marketplace consumers to save their own money and demand cost-effective care at a basic level and to do all this while managing to either spend the same amount of money we're currently pouring into a broken system or to even save money while doing it.
By profession, I think and talk about health care quite a bit. Sure, it's insanely expensive; sure, it's dangerous; sure, it's appallingly inaccessible, even to people with money and time to spend trying to figure out out. But until I read this book, it didn't occur to me to question the underlying principle of our health system--namely, that insurers of various kinds (private companies, government agencies) are naturally and necessarily interposed between human beings and medical care. This book exposed that principle as a historical accident -- and the health system it sustains as a perfect machine for producing human misery and economic devastation. In making that argument, this book changed my mind about single-payer health insurance (I no longer think it'll help), about the utility of market forces (I now think they matter), and even housing policy (!). This book should be required reading for anyone in healthcare or health policy, and it would help anyone with a human body who anticipates needing medical attention at some point. Brilliant.
If you start your career at age 22 in a $35K job, work until age 65 with a 4% bump each year, you will have earned about $3.85 million over those years.Guess how much of that you will have paid into the healthcare system -- through Medicare and Medicaid taxes, through your share of premiums, out-of-pocket, co-pays, and the portion of your compensation that your employer pays in health insurance premiums.$1.9 million -- assuming that, miraculously, the costs of healthcare and health insurance suddenly stabilized to keep pace with the CPI instead of beating by 150 to 200 percent a year as it does now.David Goldhill takes a deep, deep dive into the way our healthcare system works. Or doesn't, as a nation with the best medical technology and (arguably) the most talented medical personnel has outcomes that are middling at best.He explains why our current financial model for healthcare is unsustainable (obviously, since it eats half our incomes). But he also explains why "Medicare for all" or any third-party pay system will never control costs.This book is a must-read for anyone involved in making healthcare policy. And for anyone who'd like to find a way to not pay half his or her income for healthcare insurance and services. And, yes, it offers a realistic, tested and proven solution -- an example in which superior outcomes are provided at significantly lower cost in a nation whose demographics closely reflect our own.
I’ve worked in healthcare administration for the past 5 years, during which I’ve read many takes on the issues plaguing our health system. As someone who came into healthcare from outside industries, I love my work but have often been stunned by levels of inefficiency and dysfunction that would never be tolerated in any other sector. I’ve never read anything, however, that makes full sense of what I’ve experienced....until now, that is. Goldhill breaks down the root cases of our system’s problems in a way that almost anyone can understand. And his solutions? Jarringly simple, yet logically sound. Brilliant stuff.
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