Paul Starr

In Catastrophic Care, David Goldhill quotes Starr — “the great historian” — to state the canonical justification for insurance-funded health care: “In any given year, the most costly 5 percent of people account for more than 50 percent of health-care costs, and the top 10 percent of people account for 70 percent of costs.” Goldhill uses this concentration-of-costs argument as the expert consensus he then rebuts: the catch, he argues, is that “in any given year” annual utilization is concentrated for all expensive goods (cars, refrigerators, weddings, houses) — yet none of those rely on insurance to fund routine purchases, and nearly all of us will land in the high-use bracket at some point in life. Starr thus stands in the book as the articulate voice of the orthodoxy Goldhill is dismantling.

Context: Paul Starr is a Princeton sociologist and historian whose The Social Transformation of American Medicine (1982) won the Pulitzer Prize and the Bancroft Prize.

Where this appears

• Catastrophic Care — quoted as the authoritative statement of the cost-concentration rationale for insurance, which Goldhill then rebuts.