Dr. Vivian S. Lee is a radiologist and health care executive. A Senior Fellow at the Institute for Healthcare Improvement (IHI) in Cambridge, Massachusetts, and an NIH-funded investigator at the University of Utah.
The United States spends trillions of dollars on healthcare every year, but our outcomes are worse than those of other countries that spend less money. Why? Physician and healthcare executive Vivian Lee explains the psychological and economic incentives embedded in the American model of medicine, and makes the case for a different way forward.
In Episode 143 of Hidden Forces, Demetri Kofinas speaks with Vivian Lee, President of Health Platforms at Verily Life Sciences (an Alphabet company) about America’s broken health system, how to fix it, and why it’s been so difficult to do until now.  According to an Institute of Medicine 2012 study, we waste 30 cents of every dollar we spend on health care. That’s over $1 trillion per year. Nearly one-fifth of the US economy goes to pay for health. That’s two to three times more than other high-income OECD nations where health coverage is universal. And yet, our life-expectancy statistics place us 26th out of 35 among those same OECD countries. How is this possible? What you are going to learn today is that while the solution to America’s broken health system is complicated, the problem is rather simple: our incentives are totally “out-of-whack.” Our fee-for-service system rewards action, not better health outcomes. It encourages overtreatment and specialty care at the expense of prevention and primary care. This is the fundamental flaw of American health care. But this isn’t the entire story. How we pay for healthcare is equally important. Most Americans don’t buy health care. They buy health insurance. This incentive structure often puts insurers and doctors at odds with patients’ interests. Insurers who pay doctors and hospitals for care are incentivized to spend as little as possible on a patient’s health. The less they payout, the more profit they make. Conversely, in a pay-for-action model, most doctors and hospitals are incentivized to spend as much as possible. This means patients (or more precisely, their premiums) are the rope in an annual trillion-dollar tug of war. Doctors and hospitals pull by ordering more tests and operations; insurers yank back by denying those services or adding restrictions like “prior authorization” paperwork for expensive medication and tests. When hospitals or doctors charge more than insurers are willing to pay, patients can get caught in the middle and be asked to pay the difference, leading to those so-called “surprise bills” that we all love so much. Normally, we could expect market forces to drive costs down in such a highly inefficient system, but the model of buying insurance (not health care) means not only that customers are price inelastic, but that they are actually incentivized to consume as many services as possible since they have already paid for them in the form of a monthly premium. Everyone is shooting in a different direction. In today’s conversation with Vivian Lee, you are going to learn how America’s health system became so dysfunctional (e.g. defensive medicine, poor primary- and self-care, astronomical end-of-life costs, etc.) and what we can do to fix it. If you enjoyed listening to today’s episode of Hidden Forces you can help support the show by doing the following: Become a premium subscriber, which gives you access to our episode overtimes, as well as transcripts and rundowns to each week’s episode. All subscribers gain access to our overtime feed, which can be easily added to your favorite podcast application. Subscribe on Apple Podcasts | Spotify | Stitcher | SoundCloud | YouTube | CastBox | RSS Feed Write us a review on Apple Podcasts Subscribe to our mailing list through the Hidden Forces Website Producer & Host: Demetri Kofinas Editor & Engineer: Stylianos Nicolaou Subscribe & Support the Podcast at http://patreon.com/hiddenforces Join the conversation on Facebook, Instagram, and Twitter at @hiddenforcespod Episode Recorded on 06/24/2020
Dr. Vivian S. Lee is a lifelong academic and healthcare executive who is dedicated to improving our healthcare system with policies, technology and educational strategies that help make health a realistic and affordable outcome for all.Dr. Lee's newest book is available now: The Long Fix: Solving America's Health Care Crisis with Strategies that Work for EveryoneLearn more about Dr. Lee at her website: https://vivianleemd.com.You can follow Dr. Lee on Twitter: @vivianleemdBecome a Patron!Help us grow and become a Patron today: https://www.patreon.com/smartpeoplepodcastSponsors:Mint Mobile - Cut your wireless bill to 15 bucks a month at https://mintmobile.com/smart.BetterHelp - Get 10% off your first month by visiting betterhelp.com/spp.Audible - Visit audible.com/smart or text smart to 500-500.Donate:Donate here to support the show!
The coronavirus crisis has reminded everyone that major reforms are needed to fix the flaws of the U.S. healthcare system. Beyond the huge expense and vast amount of waste, the quality of care varies wildly, and millions of Americans can't get care when they need it.  Physician and health care CEO Dr. Vivian Lee draws on her deep experience of the public and private sector to call for a pragmatic and sweeping set of reforms. They include ending the current fee-for-service model and improving price transparency.We discuss the findings of her new book, "The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone.""The silver lining of the COVID 19 is that we've seen a rapid shift to alternative ways of caring for people," says Dr. Lee. Tele-medicine and technology can help lead to better access and healthcare for everyone.Recommendations: Richard gives his thumbs up toTV series: "State of Happiness" and "Halt and Catch Fire"  See acast.com/privacy for privacy and opt-out information.
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