Thanks to Paul Levy’s Running a Hospital blog for putting me onto this article. I started reading this too late but could not pull myself away from it.
If you are pondering health care reform this season, “How American Health Care Killed My Father” by David Goldhill should be something you read. He’s an outsider to health care finance and delivery and a consumer that has had the healthcare system profoundly (and negatively) affect his family.
With this personal interest, he’s become quite focused on the question: how can a technically advanced, high cost, reputable, New York area hospital with caring, highly educated and highly skilled physicians and nurses allow his father to die from a facility acquired infection avoidable (probably) by adequate hand-washing protocols? The experience has led him to an “obsession with [the] health-care system” and to start asking how could it possibly be structured the way that it is. With this background, he asks whether today’s proposed reforms actually fix what he understands to be wrong with the American health care system? His conclusion is no:
The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.
A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
I take issue with some of what he writes, particularly about hospitals. Nonetheless, it is worth a read and some serious thought, whether you agree or not with all of his statements, conclusions and his solution.