The human experience was once shadowed by the almost certain fact that you would see one or more of your children die. Now, it is haunted by a similar certainty that we will see our parents die prolonged, complicated, painful, absurd, and expensive deaths.
There is a growing group of writers of the fiftysomething generation who are taking on this subject. I am one of them, writing not long ago about my 87-year-old mother’s tortured final years. David Goldhill is another. His 83-year-old father went into the hospital with pneumonia, and because hospitals are one of the worst places for your heath, never came out.
Goldhill’s response – or revenge, because that is what we children of manhandled and tormented parents are rightly after – is a furious deconstruction of the heathcare system and why its incentives and basic economics are precisely what has given our parents such troubled deaths and, to boot, wreaked havoc on the nation’s economy. Catastrophic Care: How American Health Killed my Father is the first in-depth critique of the healthcare system by someone who is not a policy professional in the field, or a medical industry participant, or someone with a partisan interest in the outcome. Goldhill runs a company that, in fact, markets TV and online games.
If there is any common strand among the writers trying to deal with this subject – among them, Alex Witchel who wrote a memoir of her mother’s dementia, Joe Klein who wrote of his father’s death in Time, and Sandra Tsing Loh who wrote about her father in the Atlantic (where a version of Goldhill’s essay first appeared) – it is to almost wholly reject the assumptions, competence, received wisdom, and even good intentions of the experts. They’ve made this mess.
Because my siblings and I accepted such expert advice, my mother, at 84 and already showing signs of dementia, underwent open heart surgery and a valve replacements. This robbed her of all short-term memory, communication skills, and mobility. My incommunicado and diapered mom died three years later – at a cost to you, the American taxpayer, of several million dollars. (Four months after her death, these bills – or “statements” – continued to arrive.)
Here’s the thing, almost everybody can expect to have his or her parent meet a gruesome end. It isn’t just feckless doctors who are to blame, or the unintended effects of ever-more powerful medical technology. But, in Goldhill’s explanation, we live in an out-of-control healthcare economy where uncontrolled demand (we want any “healthcare” that can be provided, not least because we don’t think we are paying for it) is met with ever-increasing supply (solutions that did not exist before, for problems that did not exist before). We are gluttons for healthcare.
That is bad for our parents’ well-being. But it is also, in Goldhill’s simple math, our inevitable economic ruination. And it is worse than simple ruin: a calamitous share of our national wealth is going for care that has a negative effect on our health.
The book encapsulates, in an easy and transparent narrative, the stupidity, illogic, bureaucratic stubbornness, political expediency, and too-big-to-succeed ethos, that runs the system. Obamacare may be more compassionate than anything the Republicans offer, but it is not any smarter. And it is just as doomed.
No one in the healthcare ecosystem – island people, in Goldhill’s phrase, living in a world apart – understands the most obvious normal-world reality. This condition is algebraically compounded by the media, which understands even less. Curiously, though, as Goldhill eloquently deconstructs, the problems are not that difficult to grasp.
We have made insurance the fundamental mechanism and metaphor of the system – but we are insuring not against risk, which is the premise of insurance, but against inevitability, which is that we will all need to use our insurance. That means this is a pyramid scheme heading toward certain bankruptcy.
We have put decision-making into the hands of surrogates: insurance company’s, bureaucrats, and politicians. They negotiate for us, and make the most basic consumer choices – with no accountability to our interests or to the market. The idea of what is healthcare, or what is health-giving, and what is covered under that notion, expands at an astounding pace. Hence, the shibboleth and moral imperative that everyone has a right to healthcare simply makes no sense anymore.
In one way, Goldhill is saying that the Republicans are more right than the Democrats (he dismantles Medicare in a few pages). But he is saying this not as a function of partisanship but of language, for here is his straightforward explanation of how the system, divorced from the market, has run amok. On the other hand, he would not want to give the system back to the Republicans because their own language is, like that of the Democrats, “incoherent”.
Everybody engaged with the system is tainted by it. It’s like communism.
Ultimately, Goldhill’s solution is very basic: we ought to be insured for catastrophic events, and we ought to pay out of pocket for everything else. He vividly reminds us: we’re already paying for it – almost $750,000 over an average American’s lifetime is taken from every one of us to fund this colossus. Letting us each spend that money ourselves would immediately make for a more equitable and better-performing system. (He offers a straightforward plan about how this could be done.)
The book is powerful – edge-of-the-seat riveting – because it is not, in any sense, a policy book. Rather, this is a story about saving ourselves. And more immediately, about saving our parents. They all have an appointment with a system that will – through its incentives to act and react ever mindlessly, spend and bill, in an automatic effort to ward off the death that will curtail the need to act and react, spend and bill – cause them vast and unnecessary suffering.
And Goldhill’s book does something else. It steps outside of the established political debate and lexicon – one of the rare books addressing a major national policy issue that is able to do so in language not already debased by the problem itself.
The fury in America toward the centers and systems of power (include whoever you want here: healthcare, banking, politics, media) is most of all about intellectual corruption. The powerful talk the talk, which is a language designed to obscure the issues and keep us all out of the game. If you join it, if you learn their language, you are corrupted by it, too.
Everyone of us who has had a parent die a tortured death is searching for information about how this ever could have happened. Our guilt demands an explanation.
Alas, healthcare civilians can’t actually read most books about healthcare (and if you can, then you are part of the problem). But you can read this one.
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