Awards presentation celebrates work, grieves tragedies, explores potential reforms #ahcj13

Grace Rubenstein

About Grace Rubenstein

Grace Rubenstein is an independent journalist in Sacramento, Calif. She is attending Health Journalism 2013 on an AHCJ-Rural Health Journalism Fellowship, which is supported by the Leona M. & Harry B. Helmsley Charitable Trust.

The presentation of the 2013 Awards for Excellence in Health Care Journalism at Health Journalism 2013 was a blend of irreverence and reverence, celebrating journalists’ work exposing health care and public health problems while acknowledging the tragedies that lie behind the stories.

It began by applauding the award winners for addressing hospital costs, lead poisoning, obesity and the national fungal meningitis outbreak, among other pressing topics. Broadcast reporter Kelley Weiss continued the ceremony by testifying to AHCJ’s support for her growth as a journalist, allowing her to go behind the scenes at the U.S. Centers for Disease Control and Prevention, coaching her through her first experience filing a public-records request, and leading her to a job she loves at the California HealthCare Foundation’s Center for Health Reporting.

And then David Goldhill took the stage, and the celebratory tone changed.

Goldhill, who is president and chief executive officer of the cable network GSN, described his family’s battles with health care failures and hospital billing errors, captured in his new book “Catastrophic Care: How American Health Care Killed My Father — And How We Can Fix It” (Knopf). Several years ago his father went into the hospital with apparent pneumonia and within weeks died of secondary, preventable infections. More recently, his young son needed an emergency appendectomy. The family had to fill out the same detailed forms twice and wait five hours for surgery, while the boy was doubled over in pain, and a morphine prescription took 90 minutes to arrive even with the pharmacy a mere 100 feet away.

Why are such experiences so dishearteningly common? Because, he said, the incentives in the health care system are fundamentally broken: The way to make money in health care is by “practicing excessive care at high prices, at questionable value.”

Goldhill enumerated our misconceptions about health care structure, performance and costs. The predominant thinking these days is to bring down prices by bringing down costs, he said, but in fact “Costs come down only when prices do.” Yet the healthcare market lacks competition. And in the U.S. we have an inability ever to say No in medicine: Everything that is requested is performed. He noted, for instance, that one in three seniors has surgery in the year before their death.

The industry, he said, needs a feedback loop. Its challenges and complexity are not unique: “What’s unique is we’ve given it a pass.” Consumers should be entitled to express their buying power and demand the same service, consistency and quality that they expect from other businesses.

Our expectations of insurance are misguided, he added, pointing out that an average U.S. woman who has a family and two children and works and earns a paycheck will spend $1.8 million on health care in her lifetime (one-third from her own pocket and the rest from “invisible” sources such as employer and payroll contributions). Goldhill argued that amount is more than almost anyone will use in medical services in a lifetime. As with fires and floods, he said, health insurance should be restructured to protect us from catastrophic events, while the predictable costs of normal events — including end-of-life care — should be funded by personal savings.

He challenged the contention that consumers don’t know enough to be put in charge of their own health care. Our present mediators — public and private insurers — are doing a terrible job, he said: “A system based on our needs instead of theirs will work better. Even if we’re idiots.”

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