David Goldhill
Founder and CEO of the healthcare marketplace Sesame, former entertainment executive, and author of Catastrophic Care
David Goldhill (Founder and CEO of the healthcare marketplace Sesame, former entertainment executive, and author of Catastrophic Care) has appeared as a guest on 1 episode in TMT. Topics they speak about most include Third-party payment in healthcare, Medical innovation funding, Sesame (healthcare marketplace).
In their words
Positions and remarks grouped by topic, each with the exact quote and where it was said.
Third-party payment in healthcare
Goldhill argues that no one in healthcare can become more profitable by lowering prices, unlike in other businesses.
“Nobody in the healthcare system can make more money, can be more profitable by lowering their prices”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 14:57
Goldhill recounts that despite having open-heart surgery costing about $120,000-130,000, his $35,000 annual family premium makes insurance a bad deal for him.
“So roughly every four years, I pay for an open heart surgery, and I guarantee you we're not using one every four years”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 13:01
Goldhill contends that third-party payers ask for a 'fair price' rather than letting competition drive prices to marginal cost.
“there's almost no corner of healthcare in which we let good old-fashioned competition drive people's prices down to marginal cost”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 10:30
Medical innovation funding
Goldhill argues that adopting a British- or Canadian-style system would destroy the engine of medical innovation.
“If we just go to a sort of socialist system, a British-style system, a Canadian system, we'll simply destroy the engine of innovation”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 6:59
Goldhill argues Americans pay 70 to 80 percent of the cost of innovation while receiving a small fraction of the benefit.
“We're paying 70%, 80% of the cost of innovation and getting 3%, 4%, 5% of the benefit, maybe 10% of the benefit”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 7:11
Goldhill argues that because the US has the only free-enterprise healthcare system, almost all global medical innovation is designed for the American market.
“that's why almost all of the innovation in health care on Earth is designed for the American market”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 2:33
Sesame (healthcare marketplace)
Goldhill says many top doctors want to leave the third-party payment system because they spend too much time on insurance paperwork.
“Because I didn't go to medical school to spend 20% of my time as an insurance clerk”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 52:47
Goldhill argues consumer-driven markets work because sellers chase consumers, not because consumers do extensive research.
“Consumer-driven economies aren't driven by consumers. They're driven by sellers chasing consumers”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 49:45
Healthcare in the United States
Goldhill argues that government and insurance workers are trying to do well, and that incentives rather than villains cause the system's failures.
“People who work in insurance companies overwhelmingly are trying to do well. It's the problem is incentives always win”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 41:00
Goldhill states that the US accounts for 40 percent of world healthcare spending while having 3 percent of world population.
“the United States is 40% of world health care spend. We're 3% of world population”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 4:51
Medicaid
Goldhill says big insurers have become 'wards of the government' because much of their revenue comes from running Medicare and Medicaid.
“the big insurance companies now are basically wards of the government”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 45:17
Hospital business model
Goldhill argues general hospitals lack economies of scale or scope outside reimbursement rates and are unlikely to win over time.
“Outside of reimbursement rates, hospitals don't really have economies of scale or of scope. They're kind of a senseless institution”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 44:08
Hospice care
Goldhill notes that when Medicare first covered hospice on a per-day basis, providers admitted patients who were not dying, the opposite problem.
“They were paying per day And people were taking hospice patients who weren't really dying”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 38:07
Telemedicine
Goldhill predicts telemedicine will be highly disruptive because fewer conditions require a doctor to be physically present.
“Telemedicine and remote medicine generally are going to be extraordinarily disruptive to healthcare if we allow”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 28:57
Artificial intelligence
Goldhill says the biggest impact of AI on healthcare so far has been in revenue management between providers and insurers.
“To date, the biggest impact on AI on healthcare has been in revenue management”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 23:13
GLP-1 receptor agonists
Goldhill argues that weight-loss drug prices fell because insurers did not cover them, forcing direct-to-consumer sales.
“The insurers didn't cover them, and the prices came down. There's an important lesson to that, right?”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 18:48
Catastrophic Care
Goldhill says his 2012 book estimated an employee would put $1.2 million into the healthcare system over a lifetime, with 10-15 percent going to payment administration.
“in 2012, the amount she would put into the healthcare system over her lifetime was $1.2 million into the healthcare system”
Proven Podcast: Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David Goldhill (Sep 9, 2026) · Listen from 15:33
Appearances
Healthcare Fixed: No Insurance Needed, Same Doctors, 60% Less - David GoldhillProven Podcast · Sep 9, 2026 · 59 min
Charles Schwartz talks with Sesame founder David Goldhill about why American healthcare costs so much and how cash-price markets and telemedicine could lower costs.
Often appears with
- Charles Schwartz · 1 shared episode