John C. Goodman: Healthcare Policy Analyst, Pundit

"It's not the insurance companies' fault. Government is the main problem."

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is John C. Goodman's story.

As president and CEO of the National Center for Policy Analysis, a think tank that searches for private sector alternatives to government programs that are not working, John C. Goodman is in his element when causing a stir. Whether it's being at odds with the White House or Democrats or Republicans in Congress, Goodman takes special delight in taking jabs at health policy makers.

Goodman has been doing that for more than 20 years, and over that time has been involved in the public debate, whether it's over Roth IRAs, health savings accounts, Social Security, or healthcare reform.

The NCPA had its origins in what he says was a ramshackle office building in Dallas with a constantly leaking roof that eroded his files. The first two years he was unable to raise money; he waived his salary and paid expenses out of his own pocket.

Today, Goodman has thrust himself and his organization into the thick of healthcare reform debate, especially through his well-known blog on healthcare. He has written nine books on health policy and tax issues, as well as more than 50 studies; he has testified extensively on Capitol Hill.

"We try to be objective, recognizing the costs and benefits" of reform, he says. "With the White House all you see is the benefits, they never talk about the costs," Goodman says. "I put a discussion on the healthcare blog and was accused of not being objective. I failed their test but I'm more objective than others."

But Goodman says he doesn't fight because he enjoys being in the arena. He says he can offer more in the healthcare reform debate especially with respect to economics, which he says is too often downplayed as politicians move healthcare plans along.

The result, he predicts, will be healthcare reform laws that inevitably will be reshaped or refined or even thrown out as Congress continues to tackle the issue.

For instance, while there has been much optimism over the possibilities for accountable care organizations, Goodman dismisses them as "HMOs on steroids." While the White House nurtures its healthcare reform plans, Goodman says it has not only missed its mark in attempting true reform, but is misleading the public.

In the end, healthcare reform will continue to necessitate major changes because, Goodman says, patients may get lost in the shuffle.

And when he has some free time, he tackles New York Times crossroad puzzles, sometimes spending up to two hours on a Saturday trying to solve them. He often does, taking care of them in pen, not pencil. It gets him away from one passion, politics and healthcare policy, to another—learning different subjects. "It forces me to be aware of more things going on, to pay attention; sports, Broadway, and the movies, and Greek gods," he says, laughing. He doesn't want to have "too narrow thinking" about just economics and public policy.

There is no doubt, however, that politics and health policy are his passions, and he doesn't mind a good fight over his ideas.

In the 1990s, Goodman was credited as being a key force in thwarting Hillary Clinton's proposed healthcare reforms initiated by then President Bill Clinton. Goodman doesn't talk party politics, but he does sure talk politics and does not apologize for being right of center. The Wall Street Journal has called Goodman the "Father of Health Savings Accounts" (of which Goodman is quick to remind us).

Goodman uses wit and sarcasm in his criticism of the healthcare landscape. It seems he hardly mentions the White House healthcare plans without mentioning the phrase "Obamacare."

"Before the bill was passed, they zeroed out all the money they set aside to train doctors, nurses, and paramedics personnel; so what's going to happen?" Goodman says of Congress' health reform legislation. "There will be huge increase in the demand for medical care, among the 32 million of the newly insured, and millions of those people who have no copayments, no deductibles for preventive care. The biggest problem we are going to have with Obamacare is that we have this huge increase, the demand for medical care, and they've done almost nothing to increase the supply."

The NCPA is self-described as a nonprofit, nonpartisan public policy research organization "dedicated to developing and promoting private alternatives to government regulation and control, solving problems by relying on the strength of a competitive, entrepreneurial private sector." Goodman says he is simply in favor of patient-centered, consumer driven healthcare.

When he began the NCPA in 1983, during the Ronald Reagan presidency, there was not enough debate about "social insurance areas, Social Security and healthcare and disability" Goodman says, noting those were among the reasons why he started his organization in the first place.

One of Goodman's favorite activities is engaging debate prompted by his blog, which he describes simply as the "most thoughtful conversation anywhere in health policy; you find we consistently have discussions on health issues from an economic point of view, which others do not. And with a sense of humor that you certainly don't find elsewhere."

In one blog, Goodman noted his view of pilot programs. "This is about the only idea for controlling costs in the Patient Protection and Affordable Care Act, and before I heap on all the scorn and opprobrium it so richly deserves, let me say that on rare occasions pilot programs can generate very useful insights," Goodman wrote.

Goodman says he's proud of a "consumer's guide" that the group has put together, "What Does Health Care Reform Mean to You", which he claims is the "first effort anyone has made to even try to be objective is rather amazing."

Most of the mainstream media has published 'talking points' lists of the benefits, prepared by the White House, according to Goodman. "Even health policy journals have largely ignored the costs of reform and who will bear them. On the other side, Internet screeds warning of 'death panels' have exaggerated from the opposite direction."

Although there has been much criticism of insurance companies seeking rate hikes, Goodman says, "It's not the insurance companies' fault." He adds, "Government is the main problem."

As healthcare reform moves along, and the political debate continues to unfold, Goodman says he's convinced that eventually Congress and the White House will have to make some revisions, or possibly retreat on healthcare reform. Whether it's with the Tea Party or other groups, the fighting over healthcare reform is really just beginning, he says.

Over time "we are going to start over," he says. "Two years of guerilla warfare."

And Goodman likes a good fight.