Goldhill’s *Catastrophic Care*

I guess I’ll post some things as I read David Goldhill’s Catastrophic Care: How American Health Care Killed My Father–and How We Can Fix It. I will admit up front that I’m not very excited about this. It’s not Goldhill’s fault. It’s all me. I’m just tired of health reform and the health care debate.

Don’t get me wrong, it’s an important debate. It’s just that I feel like I’ve seen and heard it all already, and blogged on just about every issue that is of interest to me. I’ve been letting a lot of stuff go by lately for this reason.

On the other hand, it could just be a phase, and I’ll get fired up again in a few weeks. It’s happened before. As I wait, I will drop a few notes about Goldhill’s book. It really is the only way my brain will remember anything about it. I won’t be comprehensive. I will deliberately not wrestle with everything I find problematic or praise everything I like. It’s the best I can muster. Read along and join in in the comments.

The introduction includes this:

[T]he frustrating reality is that despite more than sixty years of government efforts — representing the work of both political parties — we are moving further and further away from what we want. Prices are higher, more people are excluded from needed care, more excess treatments are performed, and more people die from preventable errors. Why?

That’s a huge invitation to point out that efforts at changing the health system haven’t been entirely public sector. I can think of some private-side innovations and developments. But you know where this argument is going. You’ve seen it before. Go ahead and debate public vs. private in the comments. It’s the classic conundrum in health reform. Important. But old.

All in all, the introduction is making two points I fully agree with. In one of my talks, I put it this way: As costs escalate, the health system has remained stubbornly unresponsive to both consumers and evidence. If this isn’t shocking, you’re as numb as I am. Consumers — patients — are the reason for the system’s existence. Evidence is what gives it credibility. So, the system is failing to serve its intended role and failing to do so in a trustworthy way. In a (generally) capitalistic economy and (broadly) free culture, if anything isn’t sustainable it’s this. Someday some of the constraints will loosen and the perverse incentives unwound. I don’t know when, but it’s coming.


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