The Long Fix

March 15, 2020
Physician, scientist, and health care administrator Lee charts a new and improved system that lowers costs while providing more efficient service. Lee, president of Health Platforms at Verily (formerly Google Life Sciences), is appalled by the current state of health care in the U.S., where spending is "rapidly approaching $4 trillion per year," far more than in countries that provide universal coverage--and our results are worse. In a nation in which 10% of citizens don't have or can't afford health insurance (and millions are underinsured), the landscape is dire: We waste 30 cents of every dollar spent on health care, 20% of medical care is unnecessary, medical errors are the third-leading cause of death, we forego preventative care, and we push high-cost, branded drugs instead of generics. Although Lee sometimes drifts into insurance-speak--"the Bundled Payments for Care Improvement pilot project"--she mostly presents sensible options: "Pay for results instead of action" (collaring costs, predicating fees for results); set expectations of zero tolerance for serious medical errors; giant providers (such as Medicare and the Veterans Health Administration) should negotiate prices; take cues from successful "employer-driven and government-run health systems"; and understand that it will take time to build "on the vital roles that everyone needs to play." Lee believes that the fee-for-service models undercut doctors' intrinsic motivations--such as purpose and mastery--and that it is crucial for patients to become fully engaged in their health care. Of particular value are the action plans that conclude each chapter, which contain countless helpful suggestions for patients, consumers, physicians, health care professionals, health care payers, and policymakers. These include tapping into big data (with buffers for privacy), a 10-point plan for employers, and a health system that learns from its results and acts on them. A health professional turns an experienced eye toward sensible, ground-level actions to make medical care better and cheaper.

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May 1, 2020

Lee draws upon her experience as a physician and health care administrator to present a plan for remaking the U.S. medical industry. She argues that the current fee-for-service model inflates costs by rewarding the number of tests and procedures performed; currently, doctors have a financial incentive to overtreat patients. She maintains that we would be far better served by paying for results. Care should be standardized based on evidence: which treatments produce the best outcomes? The true cost of procedures and prescriptions should be transparent to patients, she continues, and every aspect of the payment system should be simplified and standardized. Existing electronic health records hold vast amounts of data that should be mined to provide patients with information about which doctors and procedures have the best outcomes for the least cost. Lee presents the Military Health System and the Veterans Health Administration, not Medicare, as the best models for government-managed health care. Each chapter ends with action plans for patients, physicians, payers, and policymakers to improve the nation's health. VERDICT Relevant to all who provide or receive health care in America.--Rachel Owens, Daytona State Coll. Lib., FL

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April 15, 2020
Lee convincingly argues that the U.S. medical system overtreats patients, makes deadly mistakes, wastes money on bureaucracy, pushes expensive new technologies that aren't any better than cheaper alternatives, waits until uninsured people are too sick, and fails to get people to change unhealthy behavior like physical inactivity and using tobacco. With impeccable credentials (an M.D. from Harvard, a Ph.D. from Oxford, an MBA from NYU and past posts as chief science officer at NYU's medical center and CEO of University of Utah Health), Lee speaks with authority. She urges patients to learn more about their medications and to make sure they're needed; physicians to take responsibility for the financial toxicity of prescriptions, and policy makers to demand price transparency and to ensure that a national supply of vital medications is always available. The U.S. needs more health professionals like physician assistants and social workers and others who can help with prevention and home care. Especially in light of the coronavirus emergency, Lee's call for everyone to play a role in the Long Fix rings true.(Reprinted with permission of Booklist, copyright 2020, American Library Association.)