Introduction: How American Health Care Killed My Father
Becky is a twenty-six-year-old who's worked in my company's marketing department for three years. It's her first job out of school, and she's done very well. She's smart, ambitious, and poised, and her future is promising.
Becky describes herself as a "bit hypochondriacal," so she sees two primary care physicians a year. But she's generally healthy and has no major health care needs. With the insurance plan she's chosen, she can see any doctor she wants, but the annual deductible doubles, from $250 to $500, when she goes out of network. Most of the treatments she uses count as preventive care, which now has no cost sharing. So with her share of the company's insurance premiums and her out-of-pocket expenses, health care will cost Becky just about $2,500 a year. That may be a bit more than she would like, but all things considered, it's not terrible for someone just starting out, right?
Becky will actually contribute over $10,000 to America's health care system this year—most of it through payments she's not aware of. That's right: health care will consume just under a quarter of Becky's true compensation, not the 7 percent she believes. I'll be providing a detailed breakdown of these additional—I call them deliberately disguised—costs in chapter 2. For now, what you urgently need to understand is that beginning on the first day of her working career, the cost of health care will be the major constraint on Becky's standard of living matching—much less surpassing—that of her parents.
And it will only get worse for Becky as she settles down and starts a family. Because, as I'll show you, even if we somehow eliminate the explosive growth in health care costs—literally reduce growth to zero—our current system already ensures that Becky will pay well more than $1.2 million into it over her lifetime. If Becky's hoping the new Affordable Care Act will somehow reduce her cost, then she's unaware that the administration's own projections show per capita health costs rising by 5 percent per year over the next ten years (which would mean her lifetime contribution to the system will be $1.8 million, even assuming that after those ten years health costs don't grow at all). All this assumes she never has a major illness, in which case she will almost certainly pay much more.
None of this is on Becky's radar screen today. Although she's probably spending more this year on health care than on anything else (except maybe big-city apartment rent), and while she describes herself as a "true bargain shopper," Becky has no awareness at all of what health care is really costing her. She thinks about her health care benefits, not about her health care costs.
Becky hopes to be successful, perhaps someday earning "several hundred thousand" a year. That would put her in the top 1 percent of earners in America. When I ask her how much she would need over her lifetime to pay for health care, she mentions the possibility of dealing with cancer or other major issues and says "millions." There is "no way" she could afford to pay for her care on her own. But then I ask her how a society can afford health care for anyone if even people in the top 1 percent don't have the resources to cover their care. Where would the money come from? She's a bit embarrassed: "I'm sorry, that doesn't make any sense. I haven't really given this any thought." I assure her there's no reason to be embarrassed: almost no one seems to have given this much thought.
I started thinking about health care because of a personal tragedy: almost three years ago, my father died from a hospital-borne infection he acquired in the intensive care unit of a well-regarded New York hospital. Dad had just turned eighty-three and had a variety of the ailments common to men of his age. But he was still working the day he walked into the hospital with pneumonia. Within thirty-six hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, all contracted in the hospital, overwhelmed his defenses and caused him great suffering. But although his death was a deeply personal and unique tragedy for me and my family, my dad was merely one of a hundred thousand Americans who died that year as a result of infections picked up in hospitals.
One hundred thousand preventable deaths! That's more than double the annual number of people killed in car crashes, five times the number murdered, twenty 9/11s. Each and every year!
A few weeks after my father's death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost's solution? A simple checklist of ICU protocols for physicians and nurses governing hand washing and other basic sterilization procedures. Hospitals implementing Pronovost's checklist achieved almost instantaneous success, reducing deaths from hospital infections by more than half. But many physicians rejected the checklist as an unnecessary and belittling intrusion, and many hospital administrators were reluctant to push this simple improvement on them. Gawande's article chronicled Pronovost's travels around the country as he struggled to persuade hospitals to embrace his reforms.
It was a heroic story, but it was also deeply unsettling. Why did Pronovost need to beg hospitals to adopt an essentially cost-free idea that saved so many lives? In an industry that loudly protests the high cost of liability insurance and the injustice of our tort system, why did a simple and effective technique require such extensive lobbying?
And what about us—the patients? Our nation is quick on the draw to close down an imperfectly assembled theme park ride or a business serving an E. coli–infused hamburger. Why do we tolerate the carnage inflicted by our hospitals? The hundred thousand deaths from infections are compounded by a litany of routine mistakes that create preventable blood clots, drug dosage and prescription errors, and any number of other oversights. All this adds up to an estimated two hundred thousand Americans killed each year by medical mistakes. A single fatal accident at a school or even a nightclub will make headlines in your hometown newspaper. How did Americans learn to accept hundreds of thousands of deaths from avoidable medical mistakes as an inevitability of the system?
Excerpted from CATASTROPHIC CARE: How American Health Care Killed My Father—and How We Can Fix It by David Goldhill. Copyright 2013 by David Goldhill. Excerpted by permission of Knopf, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.