Prevention Matters

Business executive David Goldhill writes a passionate piece in the current edition of The Atlantic entitled "How American Health Care Killed My Father." Goldhill, whose father died of a hospital-borne infection at New York City institution, says the perverse sets of incentives within the current system aren't worth keeping.

"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results," Goldhill writes. "Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value."

Goldhill recalls Dr. Peter Pronovost 's attempts to reduce the incidence of fatal hospital-borne infections by using a simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures.

"Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption," he said. "But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them.

"My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals," Goldhill says.

"How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people."