Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong

Author: David Goldhill
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by evanagon   2018-11-10
Yep. There's a book that does a good job outlining the main problems in the healthcare industry: "Catastrophic Care" by David Goldhill.

The big issue, as you mention, is health insurance companies themselves. They aren't actual insurance companies—they are payers, like others in this thread have called out. Real insurance exists when unlikely but disastrous events occur, like a house fire or a car accident.

Payers act more like surrogates—they bargain and make purchasing decisions on behalf of users like us. This is the fundamental problem in healthcare because surrogates cannot make financial decisions as well as a free market can.

Goldhill’s proposal for changing the industry is to eliminate the role of surrogates and replace it with a version of a health savings account that everybody would be required to contribute into and carry indefinitely, and require everybody to have a very high deductible catastrophic insurance plan. For example, all healthcare payments under $30k would be paid for directly by the patient and come out of the savings account. When something truly big and expensive occurs in a patient’s health (e.g., a cancer diagnosis) is when catastrophic health insurance would kick in and cover it.

This would allow for patients to make active decisions about which type of care to choose, and would force providers to become more competitive to earn the business of actual customers.