Goldhill's remedy for the country's ills comes in two parts. For catastrophic care, what he defines as "crises that are major, rare, and unpredictable," there would be government-run universal coverage, much like homeowner's insurance that pays when your house catches on fire.
For everything else, non-emergent care, preventive health and elective procedures, each person in the country, including seniors or their designated decision makers, might receive a sum of money to spend, say $5,000, or $8,000, like an accumulating health savings account, based on what would ordinarily be spent on healthcare a year anyway.
Or maybe we'd just eliminate the billions in premiums paid by employers and employees from their paychecks, or the Medicare payroll taxes that revert to Uncle Sam. In other words, he wants to take insurance companies, Medicare and Medicaid largely out of the picture.
The idea that Medicare or Medicaid can force higher quality from its qualified providers because it pays them, or that health plans select providers who perform better is lunacy, Goldhill says.
"I would argue that anyone relying on their insurer to pick the right hospital for their specific treatment, is kidding themselves," he says.
In Goldhill's new world, each person would get to spend their thousands the way they wanted directly each year, or save it until they needed it, for services by the providers they wanted. No "surrogates" or middlemen would dictate networks of care to get in the way, Goldhill says.
Only then, when consumers become direct payers for their healthcare, can they have the market force they need to demand accountability and transparency in the quality of the services they receive, he argues. Today, when someone else is paying the bill, consumers don't impose the same level of scrutiny, saying in effect, "if it's paid for, I must need it."
"How do you introduce the type of dynamic accountability and discipline we have in everything else?' he asks. "You do it by forcing providers to chase customers, like they do in every other industry," Goldhill says. "And you take the functions that we now give insurers and Medicare and you give them to people who are actually putting up the money and receiving the service," Goldhill says.