The Long Fix: Solving America’s Health Care Crisis with Strategies That Work for Everyone by Vivian Lee.

5/5 rating. 208 pages.

Book #37 of 2021. Read April 26, 2021.

I have read 442 books since the beginning of 2017 and this is one of the 3 best out of all of those. EVERYONE should read this book about how we can change our healthcare system.

Each and every person is impacted by the choices that not only you, but your insurer, the government, and the hospitals make about your health. It’s time to stop being passive consumers of the single most important service in our lives: healthcare. Vivian has held many important positions within the healthcare field, and she has used her experience and research to come up with the ways that our system is most broken. I think even more importantly, at the end of most of the chapters, there are steps that we all can take to improve these systems: whether you are an insurer, a medical professional, or just a consumer of healthcare.

Unlike “The Healing of America” this book is much more based on the healthcare itself as opposed to the insurance system. Vivian makes the absolutely obvious statement that we need to shift from pay-for-service to pay-for-results. In what other realm would we pay just because something was done? Who cares if 100 different tests were completed but you are no closer to being properly treated? Along with this, there needs to be vastly more transparency in the medical system: did you know that it’s not just you who doesn’t know how much care costs? Almost no one in the system knows the costs, what kind of “business” is this!?!

It may be counter-intuitive, but as Vivian says: “If our nation stopped expecting quick fixes—a prescription, a referral to a specialist, an MRI, an operation—and instead put a premium on measurably improving lives for good, then prevention would become paramount. The medical world would focus on diet, sleep, and fitness.”

Fixing our healthcare will certainly not be easy, but if everyone reads this book and starts to push for the ideas that Vivian recommends, maybe we can start to turn it around and make a healthier America.

Quotes:

“Hands down, the United States spends more on health care per capita than any other nation—nearly one-fifth of the US economy goes to pay for health. That’s two to three times more than other high-income Organization for Economic Co-operation and Development (OECD) nations like the UK, Canada, Germany, Japan, and Australia, where health coverage is universal. Despite this, about 1 in 11 Americans don’t have health insurance and can’t afford care.”

“Babies born in the United States in 2017 are expected to live 78.6 years, 5.6 years less than those born in Japan, which places us 26th out of 35 OECD nations in life expectancy.”

“The Institute of Medicine (now National Academy of Medicine) estimated in 2012 that we waste 30 cents of every dollar we spend on health care. That’s over $1 trillion per year. Some of the waste is fraud and abuse, but most of it comes from failures to care for patients properly.”

“In the United States, about 8% of spending on health care is spent on administration.”

“We put people in hospitals who would be better off at home. In the hospital, we attach them to costly life support systems, even when they have asked to be left alone. While four out of five people would prefer to die at home, only one out of five does. Most people still die in a hospital or nursing home.”

“Our system rewards action, not better health outcomes. It encourages overtreatment and specialty care at the expense of prevention and primary care.”

“If our nation stopped expecting quick fixes—a prescription, a referral to a specialist, an MRI, an operation—and instead put a premium on measurably improving lives for good, then prevention would become paramount. The medical world would focus on diet, sleep, and fitness.”

“Because we have an insurance model of paying for health care, the normal economic rules of the market don’t readily apply.”

“Health systems like ChenMed that are paid to keep patients healthy recognize that what happens to patients in their clinics is often less important to their health than their circumstances at home: whether they are financially secure, have access to fresh food, live and work in a safe environment, and have adequate access to transportation and housing.”

“One study estimated that about 25 cents of every dollar collected by a hospital is spent on administration, which means American hospitals spend more on paperwork than they do on nurses.”

“Because Medicare’s internal costs for administration are a fraction of those commercial payers, Medicare-for-all could reduce administrative costs from around 14% to 6% or less.”

“If doctors and hospitals only got paid if patients did at least as well as expected, it could obviate most of the billing and coding requirements, with considerable potential savings. By simplifying and clarifying services that health insurers, hospitals, and medical groups offer, and by making information about their costs available publicly, people could make choices based on quality, accessibility, service, and other amenities, in addition to price.”

“Every time a patient receives a medication in the hospital, there’s a 20%–25% probability that it involves at least one clinical error—the drug may be given at the wrong time or at the wrong injection rate, or maybe it’s the wrong formulation.”

“This happens so often that as many as 30% of laboratory tests and 20%–50% of advanced radiologic imaging may be unnecessary, and as much as 2%–3% of health spending in the United States (over $50 billion) is considered defensive spending.”

“The number of deaths due to medical mistakes in the United States equates to somewhere between two and six 737s crashing every day, depending on which estimate you believe.”

“To transform health care, we need to align purpose, autonomy, and mastery with the delivery of better, safer, and more affordable care.”

“I’ve asked thousands of physicians and other professionals, ‘Do you know what it costs to provide health care for each of your patients?’ It’s rare that a single hand goes up. They don’t know how much it costs to run the MRI scanner or the echocardiography machine. They don’t know how much every minute a patient stays in the emergency department or intensive care unit costs.”

“A study published 12 years later found that the three expansion states had significantly lower death rates (19.6 fewer deaths per 100,000 adults per year) than their neighboring states, and people reported their own health to be significantly better. Since the Affordable Care Act, several hundred published research studies have shown that Medicaid expansion has consistently improved access to basic health care, and that people have gotten healthier because of that access—their blood pressure and diabetes are better, mental health has improved, and more have been screened for diseases like cervical and prostate cancer.”

“High-deductible health plans could benefit from redesign, too. Up to the point of the deductible, people are incentivized to avoid using any care—even when it’s sensible and necessary. If they do end up reaching the deductible, they are then incentivized to use as much care as possible because it’s ‘free.’”

“In 2018, nursing schools turned away more than 75,000 qualified applicants because of insufficient faculty and clinical preceptors.”

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