Insurance Plays Too Big a Role in the U.S. Healthcare System

Businessman David Goldhill examines where American healthcare dollars should really be spent.

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When David Goldhill's father died from an infection he acquired as a hospital patient, the president and chief executive officer of the Game Show Network decided to take a close look at the U.S. healthcare system. In Catastrophic Care: How American Health Care Killed My Father—and How We Can Fix It, Goldhill argues that the incentives within the industry are problematic. He recently spoke with U.S. News about the way the healthcare system is designed, why he thinks the Affordable Care Act is shortsighted, and where he says healthcare dollars should really be spent. Excerpts:

Why did you decide to write about healthcare?

Trying to figure out why it is that we tolerate so much accidental or error-caused death in our hospitals is really what began my exploration into healthcare and ultimately [led me to] write this book.

What is a common misperception about the way the healthcare system works?

That turning over the role of customer to giant intermediaries, like insurers, Medicare, and state Medicaid agencies, has insulated us from the real cost of healthcare and has provided somebody who is better at driving safety and quality than consumers would be.

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What's the role of the insurance system?

I think what's happened is that our correct understanding that some of our healthcare needs are best covered by insurance—emergencies, major, rare, and urgent health crises—has morphed into this view that everything in healthcare needs to be covered by insurance. And, unfortunately, insurance as a way of financing something is probably the most costly imaginable option. It not only involves a lot of administration, but it also very much distorts the relationship between provider and patient.

What about pharmaceutical companies?

Pharmaceutical companies, like everybody else in healthcare, are merely following the economic incentives that the system creates. We've built a healthcare system that incentivizes excess care, care whose benefit is poorly measured. So, while it's easy to look for villains, it's hard to ignore that the fundamental incentives we've given people caused the behavior that we then find so unsatisfactory in terms of its impact on our health.

How can those incentives be changed?

The biggest way to change incentives in healthcare is to restore as much of it as possible to a consumer economy where companies have the same pressures, accountability, and discipline that's created by needing to chase a large mass of consumers. What I think we really want to do in healthcare is run more of our funds back through the people who are actually paying for it—because we're all paying for our healthcare whether we know it or not—and less of it through the insurance system, and try to create a more normal economy of healthcare.

[See a collection of political cartoons on healthcare.]

Has the approach to the healthcare industry been wrong?

I think what happened is less that our approach to healthcare was wrong than that healthcare has outgrown the way we think about it. If we look forward, we see it's going to become ever more personal, ever more targeted, and ever more integrated into lifestyles. Our insurance-based approach is not going to be able to handle those issues because it's a one-size-fits-all approach.

What effect will the Affordable Care Act have?

Well, it will make healthcare more complicated. Its heart is probably in the right place, it's concerned about the lack of access that a significant number of Americans have to certain types of care. But the problem is it's missed all the real changes that have occurred in healthcare. The greatest problem we have is that healthcare is consuming an awful lot of resources that might be better used. I'd say there's a tremendous amount of excess care causing very real harm. And my hunch is the Affordable Care Act pushes us further down that road.

[Read the U.S. News Debate: Is Medicaid Expansion Good for the States?]

How can the patient impact healthcare reform?