'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, http://storysmith.co.