THE LONG FIX

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.