Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill

Charles goes one on one with David Goldhill, founder and CEO of Sesame, former president of television at Universal Studios, and author of Catastrophic Care, to tear apart why American healthcare costs so much and what it would actually take to fix it.

They walk through why the United States covers 40 percent of the world's healthcare spending while making up just 3 percent of the population, why insurance companies and government payers killed normal pricing, and why the fix isn't one big policy swing. It's a shift back to treating patients like customers.

The conversation covers the real economics behind a $900 million pill, why Sesame borrows its pricing model from a stone crab restaurant in Miami, why hospitals are stuck with a broken business model, and why the doctor in your neighborhood is about to compete with the best doctor on the planet.

KEY POINTS: 00:34 – Entertainment executive to healthcare founder: David walks through his path from Universal Studios and the Game Show Network to building Sesame, and why Charles calls it a classic swap from one broken industry to another. 01:57 – America is subsidizing world healthcare: David explains why the US pays 70 to 80 percent of the cost of medical innovation while capturing a fraction of the benefit, and why cutting that funding would collapse care standards everywhere. 04:04 – The NATO of medicine: David compares American healthcare spending to defense spending in NATO, and lays out the number that stops most people cold. The US is 3 percent of world population and 40 percent of world healthcare spend. 09:13 – Why the first pill costs $900 million and the second costs a penny: Charles and David break down drug pricing, and why a business model that looks terrible everywhere else works in healthcare because normal competition never gets the chance to bring prices down. 14:42 – The real lifetime cost of healthcare: David shares the number that shocked him while writing his 2012 book, what one employee puts into the healthcare system over a lifetime, and where all of that money actually goes. 27:30 – The Joe's Stone Crab model: Charles and David use a Miami restaurant to explain how Sesame built a cash pay system that gives patients upfront pricing without insurance, and why doctors are lining up to join it. 31:33 – Telemedicine breaks the map: David explains why location is about to stop deciding who gets access to the best doctors, and how remote care strips real cost out of the system instead of just shifting it around. 37:05 – What happens when incentives go wrong: Charles shares a story from his years in hospice about a system that started rewarding shorter patient stays, and David explains why neither side of that story is really about good or evil people. 44:11 – The biggest shifts in the market right now: David breaks down why patients are getting more financially sophisticated, why doctors are leaving independent practice, and why big hospital chains are structurally unable to compete on cost. 52:09 – Fighting conventional wisdom: David walks through the assumptions people in healthcare kept telling him were impossible, like doctors posting real prices, and why more of the best doctors in the country are asking how to get out of insurance entirely.

KEY TAKEAWAYS:

• Why the US being 3 percent of world population and 40 percent of world healthcare spend is the number that explains almost everything else in this conversation
• How third party payers removed the pressure that normally pushes prices down as a product matures
• Why Sesame's cash pay, upfront pricing model is pulling in doctors who are tired of spending their time on insurance paperwork
• Why hospitals keep growing their share of the healthcare dollar even though they play a shrinking role in actual care
• Why personalized, proactive healthcare cannot run on a payment system built for a world where medicine could only react to problems after they happened