Booktv streams live online for 48 hours every weekend with top nonfiction books and authors. Booktv. Org. In 2007 David Goldhills father died from an infection incurred at a hospital due to medical mistreatment. Up next, mr. Goldhill who is president and ceo of the Game Show Network contends that his fathers death was avoidable and questions how the Nations Health care system allows over 200,000 summer deaths due to air. This is just under an hour. Hello, everybody. We are going to get started, if you dont mind. Thanks to all of you for coming here today. Im a senior fellow at the Manhattan Institute center for medical progress, and we are delighted to have David Goldhill join us this afternoon. For a talk about his new book, catastrophic care how American Health care killed my father and how we can fix it. I think that theres too when i think about health care i think of to challenges of blind spots that i think conservatives have had on health care. The first is that it tends to be liberals who criticize and critique our Health Care System, largely because of the large uninsured population. And the response of conservatives is a thing to say, the Health Care System is just fine, its the best Health Care System in the world, dont mess with it, dont change it. I think the second blind spot of conservatives in general but certainly in health care is that we tend to talk about policy, Public Policy philosophically or with charts and data. And charts and data are important, but a lot of times the way liberals have one arguments is by talking about the single mother in oregon who doesnt have Health Insurance and what we need to help her, or the child was born with Cystic Fibrosis and how that child cant get Health Insurance. And these are real challenges in our system, and there are other challenges that people who are actually ensure to have coverage who are set up in the way we all think they should be who struggle with the convoluted mess, the extent and the mistakes that arise in the Health Care System. So with reflection of those two things, in reflection of those two things its not that surprising it took a lifelong democrat, David Goldhill, to write the cover story in the atlantic about how Americans Health care killed his father. American health care did not kill his father because davids father was uninsured. Davids father had insurance. Use on medicare. But because of the unresponsiveness and all the incentives and our system led american Health Care System cannot really be that concerned about the Patient First and foremost, davids father tragically died. And im sure he will talk more about that when you hear his remarks. So whats really great about David Goldhills writing, and davids book, is that he not only talks about the real people in our system who are affected, not just the uninjured, but every american who interacts with her Health Care System and, in a way that makes us understand how much better our system could be. But he critiques it from a free market point of view. He appreciates that are so me things about our Health Care System that could be better, precisely because it doesnt skew to market principles. One of the great cliches in Health Care Policy debate is that health care is different, that health care is somehow immune from laws of economics that affect every other aspect of how we live. And what david has done in his book is a Great Service in that regard and explaining how, in fact, health care is much like other sectors of the economy. David quillen up in new york outside of new york city and nassau county. His father was a psychiatrist. He went to Harvard College and then got a masters at nyu. He then became an investment banker doing Mortgage Finance at Morgan StanleyLehman Brothers where he had a front row seat to fannie and freddie, which is something we might hear more from him in the q a. And he got involved in television and he is ceo of the Game Show Network and came to policy writing relate in his life because of this tragedy that affected his life. Eroded cover story in the atlantic magazine. And then turned that into a book, and its an incredibly compelling book, which i encourage all of you to buy. Theres copies outside the animals were instructed to say that the next season of the american bible challenge, the Game Show Network highest rated show, is coming on in a few weeks. Said the Game Show Network and feel like we are not stealing its ceo from his ceo duties, and were giving them a plug, too. So please join me in welcoming David Goldhill. Im sure were going to learn a lot from him today. [applause] thank you. Im sure everyone in your region or blog, but its a thrill when, as an outsider nonexpert, youre mentioned in something. So i think you for that, for the introduction today. Thank you, everybody, for coming. I am here really because of what happened to my father. It is what got me interested in health care. Some of you may know the story. My dad died of infection acquired in a hospital, a series of infections actually, and it was very painful as you can imagine an ever difficult experience to go through. Even worse for my sister whos an Emergency Room Physician and watched sort of helplessly as my fathers care was botched. About six weeks after my dad died, i read an article in the new yorker about viral infections which are really nothing about. I read about it because many of your probing family with, but somewhere around 100,000 americans die every year from hospital infections. Im sorry. Let me start again. Somewhere around 100,000 people die a year from hospital acquired infections, but most of them are fairly easily preventable. Not all of them but most of them. Doctors who design protocols to prevent them had failed to get hospitals to adopt them, even though they were relatively low cost. I used to run a Movie Theater chain, among many of the jobs ive held for incredible short periods of time, and when someone spilled a soda on the floor, we had a rule as to how quickly you had to mop it up so no one slipped and fell. When you read about an industry where 100,000 people die, and they could fix it and it wouldnt cost much, but they dont. I think the combination of the grief i felt for losing my father, and he sort of businessmen should gaza be about how other businesses are run made me wonder, why do we give this industry a pass about so much . I think all of you in this room, and its one of the great things about talk about health care, have been patients or have had loved ones were patients. Theres roughly 310 Million People in this country have a story about health care that we should say, why do we give this industry a pass . We would never accept this in any industry, and yet we do in health care. And others say well, its health care. Fundamentally different. What i want to talk about today is two things. One is how really it isnt fundamentally different but the way we come to think of it is, and i think its blinding us to the change in health care that has occurred since the first assumptions that guide our system and many other systems became conventional wisdom. And the second and, unfortunately, more briefly is what should we do about it, to begin to fix these problems. To me, the answer to the question of why health care in this country is so expensive, so wasteful, at the same time so often unavailable to people who needed, and delivers such unbelievably Bad Customer Service that we dont even think of it as Customer Service, is really the punchline to a number of offcolor jokes which i wont tell, but the punchline is, because they can. And to me its the most fundamental and important thing to understand about health care is that nobody else in any other service or good trying to get your business can get away with this. They cant. Someone will take your business from them. Thats not the case in health care. In health care we built a system that has the most perverse incentive and imaginable. More care over good care, more expensive care over less expensive care, and less investment in the kind of things that tell your patient customers that you care about them. Service and handling of information and all the other Little Things we see. And its great in politics to find a villain in this, the evil Drug Companies or insurers, or the unions or whoever your villain is. But the problem is, you can spend anytime health care what you find are people who are often so motivated, there are people are devoting their whole life to the care of others, even in many of the evil institutions you will find lots of people who got into it and are still in it because they think theyre helping others. So you have this interesting mix, a system that i regard as catastrophic in a number of ways, and people who seem to be motivated by greed reason for being there. And unique the bridge between understand those two, the incentives in the system, the economic incentives for bad outcomes are so powerful that it overwhelms the effort of good intentioned people. And not exactly very politically catchy phrase, right . Down with the incentives is not going to get anyone elected to power, but i think its the key to understanding how the system works. In health care we decide we dont want to be the customer. We want a circus be the customer. Private insurers are the real customer, medicare, medicaid dcms and state agencies, they are the customer. And interestingly, if you step back from the intricate debates about health care and ask yourself, how well does the Profit Center work in health care. It works perfectly. The Health Care Providers perfectly need the demands of these surrogates, which are very different from ours. I want to talk about how. Let me talk about some of the biggest assumptions we have in health care. The biggest is actually reflected in our language. Nobody, or almost nobody, almost nobody talked about health care practice. We all talk about health care costs. Its interesting in the political debate about health care. He always hear the word cost as if theres some independent thing going on, a certain amount of kryptonite that provides all the health care, we only have so much of it, its priced on another planet. Every cost as we all know is somewhat priced, the price of someones labor, the someones capital. And yet in health care i think its incredibly blinding, we think that theres a cost of things. And if we can discover it and pay as little close to it, weve done well. A lot of Health Care Policy is about discovering the cost. In the book i joke about the cost of congress. So the cost of tom cruises 20 million. Tom has just about as many molecules as any of us do. He actually is pretty much as much training as an actor as any of us do. [laughter] but none of us have any problem if youre making a movie paying the cost of congress. He will sell more than 20 million worth of tickets. Its also his price. Tom cruise goes to work as a janitor. He doesnt get to say my cost is 20 million. Because his value isnt. And yet in health care, if you listen to how we try to make it health care, its about discovering that thing, that cost, as if its independent of supply demand, technology and all the factors that tom cruise is cost of 20 million. Theres a lot of allusions in health care, and probably the most important allusion in health care i think is illustrated by what i recall the tale of two women. One of them is elizabeth warren. Elizabeth warren argued, and i think in some ways correctly, that one of the issues of the financial crisis on earth is that a lot of people applied for subprime loans without understanding what it costs them. They were misled by teaser rates or poor documentation or bad disclosure, and that this was one of the things that congress could correct them to try to correct. That very same principle, hiding from us the cost of our action, is the foundation of our Health Care System. And let me talk about a second woman who, her name is becky, and shes a 23 yearold who just towarstarted work for my compan. So in the book, in here, ill talk about what health care is going to cost becky. Like most people in the quebec he thinks someone elses magically paying for her health care. One of the fastening things that make you, becky is really successful. She probably will be. Shes an extraordinary, capable Sales Assistant about to be promoted to saleswoman, and she probably will be very successful. Becky thinks shes going to get to the top 1 of income. She also thinks she could never afford health care on her own. Now, its really a problem if the system is such that even someone in the top 1 , whos paying for the other 99 . Thats what she believes. In fact, if the cost of health care increases by exactly zero from now until becky dies, becky will put 1. 2 million in two the Health Care System. If the cost of health care increases only at the rate the Affordable Care act estimates for the next 10 years, in other words, if its successful, she will put in 1. 9 million. If she has a spouse who is working, but becky is the breadwinner and becky provides the insurance, it will add another half Million Dollars. The two of them open up at two a half Million Dollars into the Health Care System. Let me mention a couple things about becky. Shes entrylevel. These assumptions us into important things. She never gets rich. Its not her idea of whats going to happen but its statistically likely. Her income will grow two or 3 for the rest of her career. And she will never get sick. The key element of her Health Care System is her show dance. Becky thinks that im paying for her insurance. Im not, she is. One thing every economist left and right agrees on is that over time, not tomorrow, if becky walks in tomorrow and says you can have your Health Insurance back, gimme back my money, that wouldnt happen. But over time Health Insurance i think most people now know it. It is too. You would rather have them pay than not they tomorrow, but over time its often at what they were willing to pay you. Thats a big part of it. Part a we all know about Party Medicare has gone up significantly. I pay it, she pays. I paid on her behalf. She tasted. Right now 20 going up to 25 and 30 of our federal tax burden goes into subsidizing health care. Ill come back to the. 10 going to 50 of our state tax burden goes to finance medicaid. The point is when you add all this money of its a flood of money. Why does it matter . The reason it matters is, our Health Care System is so inefficient that the average person, not only could afford their health care, but would save an enormous amount of money if we transferred this money back to them and spend it to the customer. We going to do it, but it changes your perspective on whats happening. A lot of you may be thinking, that well, what about those who cant afford a . What about those who dont have a job . We will spend somewhere around 850 million on subsidizing medicare and medicaid. Its what we spent last year. We will spend more this year. You could give 100 million americans 8500 a year with that money. A family of four, 34,000, give it to them every year of their life. So, in fact, you could take our current system, our current spending, included but he come and have a completely consumer directed system. We are not going to do it but we could. Thats how much money we spent. The father, argued ago im not sure he would want to be called as the father of our system the 50th anniversary of an article he wrote saying dean of the Public Health care . Its totally different than everything else. The consumer doesnt know anything. The doctors do everything and the push. Its the argument for having and ensure or medicare or medicaid working on our behalf. The problem is that article was written in 1963. Before trip advisor. A lot of the asymmetry and information that he was writing about is the longer the case. In fact, its beyond just the fact that we can Exchange Information on the internet. Its that health care itself has changed to become far more individual, far more about probabilities and a lot less about frankly being an auto mechanic. The problem with your engine, you fix it, youre done. Very little of health is like that. Most of it is you have these alternatives, theres a variety of options depending on who you are. And affect every patient is encouraged to do this. But theres a bigger conceptual problem with what he wrote. And its the bitter problem. You probably all know the old joke about you guys being chased by a bear in the forest. One guy stopped to take office shoes and switches into speaker to his friend says you idiot, you cant outrun a bear in sneakers. He said i dont need to outrun the bear.