‘Medicare Is a Bank Without Security Guards:’ Media Exec David Goldhill vs. Princeton’s Paul Starr

David Goldhill and Paul Starr engaged in a public debate in New York City over whether the federal government should offer a Medicare-like health insurance plan to all Americans .

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On September 19 at the Soho Forum, David Goldhill, former CEO of the Game Show Network and author of the exceptional 2013 book, Catastrophic Care: How American Health Care Killed My Father—and How We Can Fix It, faced off against Princeton sociologist Paul Starr in a public debate over whether the federal government should offer a Medicare-like health insurance plan to all Americans. Star is the author of The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, which won the 1984 Pulitzer Prize for General Non-Fiction and the prestigious Bancroft Prize. (Yale political scientist Jacob Hacker was scheduled to debate Goldhill, but had to drop out because of a medical issue.)

The Soho Forum runs Oxford-style debates in which the audience votes on the resolution at the beginning and end of the event. The side that gains more ground is victorious. ​In this case, Goldhill won overwhelmingly by convincing about 30 percent of the audience to switch over to his side.

Starr, arguing for the affirmative, said that the Trump administration's "war of attrition against Obamacare" has put "us back in the world where people with pre-existing conditions can't get coverage." Expanding Medicare eligibility would provide the much needed "public option" that's missing from the Affordable Care Act, filling in for the inability of the private market to serve all citizens. And it "would not require turning health care in America upside down."

Goldhill, arguing for the negative, made a case that Medicare takes such an expansive definition of a health care "need" that ​it leads seniors to pursue unwise treatments that put their lives at risk.

Another issue is cost. Medicare proponents say that program's low administrative expenses are indicative of its operational efficiency. The opposite is true. "Private insurers say 'no' to things," Goldhill told the audience. "They judge appropriateness…Medicare's mandate," on the other hand, "is to say 'yes' to everything." The result is that there's $70 billion in Medicaid fraud every year, but the government doesn't count that as an expense.

In Goldhil's view, Medicare​ is controlled by special interests who've expanded the definition of a health care "need" to drive up costs and enrich themselves. "The degree of industry capture in the way health care policy actually happens in this country is beyond anyone's imagination," he said. The health care industry spends half a billion annually on lobbying to maintain the status quo. The nation's poorly run hospitals are able to operate at 65 percent capacity only because Medicare keeps them afloat.

"Medicare is a bank without security guards," Goldhill said, and this year taxpayers will have to subsidize the program to the tune of $320 billion.

The Soho Forum, which is run by the Reason Foundation, has a two-fold mission: to provide an arena for intellectual adversaries to talk in paragraphs (as opposed to 140 characters), and "to enhance social and professional ties within New York City's libertarian community." It's held at the Subculture Theater at 45 Bleecker Street in Manhattan, and after the debate wraps there's always free food, a cash bar, and everyone's encouraged to hang out and chat. Doors open at 5:45, and the event convenes at 6:30—at which point the party has already begun.

Next up: Yale Professor of Law Peter Schuck vs. New York Civil Rights Coalition President Michael Meyers on abolishing affirmative action. That will be on Monday October 16. Get tickets here. And subscribe to the Reason Podcast or Reason TV's YouTube Channel to catch audio and video of all the Soho Forum debates.

Shot and edited by Martin Kim at Storysmith Productions, .

'Medicare Is a Bank Without Security Guards:' Media Exec David Goldhill vs. Princeton's Paul Starr

33 thoughts on “‘Medicare Is a Bank Without Security Guards:’ Media Exec David Goldhill vs. Princeton’s Paul Starr

  1. Those who can afford health insurance buy it if they wish. People who paid into Medicare, are below the poverty level or are veterans, should be given a yearly amount at the state level (veterans at the federal level) to buy health insurance coverage.

    Obamacare, Medicaid, Medicare and VA hospitals should be phased out.

  2. Medicare patients don’t get very great treatment, and many doctors don’t take it. And just look at how the veterans clinics have been run for decades. “Medicare for all” would universalize this treatment.

  3. My drafted Vietnam vet father died at 64 from Non-Hodgkin’s lymphoma (the VA admits there is a strong link between the Agent Orange my dad described being sprayed with in Vietnam and Non-Hodgkin’s lymphoma) after spending 2 years fighting unsuccessfully for the second round of tests. (The first round of tests strongly indicated NHL but a confirmation was required) He eventually received the second round of tests (results: stage 3, about a 50% chance of cure with chemo) and chemo and prognosis was guardedly optimistic but he eventually died from the cancer.
    I’m not just un-interested in, I strongly oppose the gov. being involved in health care in any fashion.
    It, like everything the gov. does, will be more expensive and of poorer quality than what the free market provides.
    Despite the fake news statistics the left trots out trying to prove that countries with socialized medical care provide higher quality care for less cost, a conversation with users of those health care systems shows a completely different story. One of long waits for poor and rationed care. No thank you.

    • Well, yes and no. With some level of guaranteed basic coverage that was devoid of insurance company interference, you could relieve a lot of the stranglehold government aided insurance conglomerates have over consumers. Of course, that would need to be mandatory.

      Freeing up regulations, enabling insurers to charge what they want for services rendered and reneging on contracts signed due to “pre-existing conditions” would undoubtedly hurt consumers. Like it or not, the only consumer protections there are in health care, come from government regulations…
      But yeah, the Dole-plan was pretty shitty. I so wish we’d gotten the public option.

    • Why what? If two neighbors vote to rob a third, that doesn’t justify the robbery.

      The USA is a representative republic. That doesn’t justify anything either, but just a difference means.

  4. Debating who is going to pay high prices is stupid. The better question is why there are high prices. The answer is government, more of what caused a problem is not a solution to a problem.

    • Make your voices heard at the polls…Democrats will be parading this crap for years to come, as long as Bernie (good guy, but totally misguided) has political influence in the party. This will be another program that hands out TONS of money to health care lobbyists and their industry, while leaving Americans with ever-decreasing care (or exploding public debt, as politicians spend everything in their power to keep the system “looking good”, as long as people are paying attention). Medicare For All is a disaster in the making, and it appears to be possessing leftist right now.

    • Every other advanced nation in the world has some form of government-regulated healthcare and they all do it at far far less cost than the American “free enterprise” system. Having the government minding the store is better than having nobody minding the store as in America. The total overhead cost of running the Canadian healthcare system is 7 cents per every healthcare dollar. The US insurance industry skims off 32 cents of every healthcare dollar.

  5. Regardless we need to educate statists that government and private medical insurance led to this. The 1950’s healthcare system was great at providing affordability to all and high quality. Government healthcare is just cheap.

    • ÜBER Go back to germany and stop lying. The U.S. medical system is the 3rd largest killer in this country. The 1950’s was great. Btw how would you know sauerkraut?

    • Open borders work for libertarians in two spesific ways. With no welfarestate you’d have no problem with immigration. Or, with welfare state, open immigration will help to bankrupt the welfarestate, the long term goal.

  6. Paul appears to be arguing for a 2009 plan…Democrats today most certainly want “Single Payer” and “Medicare for All” is most definitely that system…he’s either being ignorant or dishonest. Bernie is a democratic socialist…of course he wants single payer, he’s said it clearly many times. Starr prefers to strawman Goldhill’s arguments rather than debate them where they actually stand. Pretty damn dishonest. It’s pretty obvious that Goldhill is making the more sound argument, but the question is: how do we get such a system with so many middle-men skimming undeserved profits off the top, while those with the least amount of income are either heavily subsidized (including for care that is unnecessary or excessive, relative to age/health/cost differentials/etc) or completely left out of the system. We need a rational system and we are unlikely to get one with a single-payer system, which Starr pretends a “public option” wouldn’t form quickly enough.

  7. A Basis Income Guarantee would be far superior to any sort of subsidies that are tied specifically to the medical industry, especially those tied to the medical insurance industry.

    • All advanced nations except the US already have healthcare for their citizens. They already have a basic guaranteed income given in the form of healthcare. They are way ahead of the US.

  8. The Problem with Health Care insurance is.. . !!!! Health Care Insurance… Health Care Should be a free market like any other business… Healthcare is not a government service. The government should have nothing to do with healthcare… H.C.Insurance should be just for accidental instances… Let people shop for services and not be forced to pay inflated rates… Our current system is a crime..

  9. Just do what other modern nations do. It works for us. Copy us, so you can finally fix this maddening problem of yours. But you won’t do that.

  10. Reasoned civil debate?   Why this isn’t a debate?  Where are the name calling and unsubstantiated claims?  I think Reason should get its act together and start stooping to other’s low levels. 😉    {SARCASM}

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