JACKI LYDEN, HOST:
It's WEEKENDS on ALL THINGS CONSIDERED from NPR News. I'm Jacki Lyden.
In 2007, David Goldhill's 82-year-old father who was in otherwise good health checked into the hospital with a minor case of pneumonia. Once there, he caught a series of infections and died. Shortly thereafter, Goldhill read an article that changed his life. He learned just how common it is for hospital infections to result in death, up to 100,000 such cases each year. He also learned how simple it can be to prevent them. In some cases, as simple as regulating that physicians wash their hands.
So Goldhill set out to learn as much as he could about our convoluted insurance-based health care system, and he found that much of it is broken. His new book is called "Catastrophic Care: How American Health Care Killed My Father and How We Can Fix It." Goldhill, who is president of the Game Show Network, approaches the topic from a business perspective, and that's why, he says, the more he learned about the industry, the stranger it all seemed.
DAVID GOLDHILL: It felt strange that any industry could have a relatively simple low-cost way of significantly improving its customer experience - and here the customer is a patient and then - the experience is a life or death one - and it would be hard to get the industry to adopt it. A hundred thousand deaths is an extraordinary number. And there are estimates of up to 200,000 people are killed by error in a given year, a variety of errors in addition to infection. And a recent study that Medicare did suggested that one out of four hospital admissions of a Medicare beneficiary involved some type of error that had a meaningful impact on that patient's health.
LYDEN: Why do you suppose we don't hear more about this?
GOLDHILL: There is a sense that there is something uniquely different about health care. You'll often hear people say that health care shouldn't be a business, as if 15 million people can perform this service without caring about their economic interests. We fund all of health care through insurance. We, as consumers, are extraordinarily passive on health care. We think because our insurer or Medicare will reimburse something, we probably should do it. It's one of the explanations why there's so much waste in health care.
And then another point in which we hold health care very different than everything else is we almost always think more of it is better. What I find extraordinary is almost anybody who looks at the Medicare program sees an enormous amount of waste. And what's interesting is we talk about the waste in terms of money. That's not the right way to think of it.
These are treatments and tests and surgeries done on people who didn't need them, shouldn't have had them. It's an assault on their bodies. And yet that kind of accountability is something that we've given health care a pass on because we feel it's just so different from any other human activity.
LYDEN: How much are we going to pay for health care over our lifetimes?
GOLDHILL: In my book, I looked at an actual entry-level employee at my company. She's earning about $35,000 a year. And I said let's look at her life. Let's assume that she's the breadwinner of the family. She does well, has a nice middle-class income. And she lives till 80, and she has a couple of kid. What is that young woman going to put into our health care system over her lifetime?
Well, the number's incredibly shocking. If there's zero growth in health care costs, she will put in - between insurance premium, taxes, Medicare, Medicare premiums out of pocket - and I should point out this is assuming she never gets really sick - she'll put in over 1 million dollars over her life to support her and her family's health care. If health care costs grow by only what the Affordable Care Act estimates, then the number is a million-nine.
But one of the foundations of our health care system is that everybody thinks there's somebody else out there paying for our health care. You know, it's one of the illusions of our insurance system. Almost everybody in the system gets in health care a lot less than they put in over their lifetime. And what we've done is we've created the scheme where nobody knows what they pay for anything.
LYDEN: Because it's so nebulous.
GOLDHILL: Because it's so nebulous and because you're never the payer. There's always an intermediary actually writing the check. And nobody knows how much they're putting in.
LYDEN: Well, where do we think the money comes from? I mean, do we think it comes from the government? Do we think it comes from the ether? Do we think it comes from Ponce de Leon's well in Florida that pulls up a fountain of youth?
GOLDHILL: Those are probably as likely a places as anywhere else. Most of us don't understand that our employer isn't really paying for health insurance, we aren't. Every economist will tell you that money, which has grown so enormously, is just coming out of our paychecks. It's a major reason that wage rates in the United States flattened in the last decade and are expected to stay flat is because your employer is paying more and more for your health care instead of paying more and more to you.
Many people think that, you know, if they're seniors, that Medicare is paying for their health care. What's interesting about seniors and what almost no one understands about Medicare is in 1965, when seniors paid for almost all of their health care themselves, roughly 10 to 12 percent of their income was spent on health care. This year, when seniors pay almost none of their health care themselves - Medicare pays 95 percent of the bill - that little 5 percent they pay now accounts for 20 percent of their income.
So what you have is people who think they're being protected by having these big intermediaries between them and the price of health care, in fact, what those intermediaries are doing is so inflating prices, so inflating demand, building so much waste and complexity into the system that all of us are bearing this extraordinary cost. We just don't see it because it's so many different hands into our pocket. But there is no other place for the money to come from.
LYDEN: We can't talk about this, David Goldhill, without mentioning health care reform. And you argue that 2010's Affordable Care Act, known as Obamacare, really isn't much of an improvement, that it's more of an extension of what's going wrong with the system. And we should note - as you do in your article and book - that you're a Democrat.
GOLDHILL: Well, I'm a Democrat, and I share what I think the administration's goal was of creating a national cradle-to-grave safety net. The problem is I think the Affordable Care Act is fundamentally old fashioned in what it understood about the health care system. It saw the big divide as being between the insured and the uninsured. And I think that's a very simplistic and probably inaccurate evaluation of what the key problems are in health care: ever greater price inflation, care that is more expensive over care that is less expensive, care that is wasteful and therefore harmful over that that is needed.
The idea of adding 16 million more people to Medicaid and the difficulty with the Affordable Care Act - like so much of the political discussion of health care - is it's all about insurance, as if insurance is health care and as if health care is health. What we have in this country is a system that is already hazardous to your health and your pocketbook.
LYDEN: What about solutions? Do we realistically think that we can improve the system that we have now?
GOLDHILL: Well, I think we see green chutes all the time in the system. And the question is not just how are we going to pay for it but how are we going to make sure that innovation, service, quality and safety in health care are truly accountable. I think we've gone through 50 years of relying on intermediaries to drive those things, and I think they failed. And so as a businessperson, I look at them and say there is no other business like that. And we give it a pass because we say health care's so complicated that's why it's like that.
I spent a lot of time in hospitals. One thing has nothing to do with another. It's the simplest thing. You go to a dry cleaner, your bill's computerized. They've been using electronic records in dry cleaners for 10 years, right? It's not because they only hired guys with computer science to be at the counter at the dry cleaner, it's that it's expensive to lose a shirt. Almost no technology in hospitals is interoperable. They don't buy interoperable technology, even information technology, which is why you fill out the same form, you know, 200 feet from where you filled it out last time.
That stuff is all about lack of accountability. The social returns to investing in technology, to information technology in health care are gigantic. But since nobody can capture those returns in a business, they're just not made. I think we need a greater role for the patient as consumer. We're going to have to take more responsibility. It probably means taking some of the 2.7 trillion that we're flowing through in insurance system and flowing it back through us as individuals so that we are the customers the system needs to chase, we are the customers the system needs to satisfy.
LYDEN: David Goldhill. He's the author of the new book "Catastrophic Care: How American Health Care Killed My Father and How We Can Fix It." David, thank you very much.
GOLDHILL: Thanks, Jacki.
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