HOW COVID CRASHED THE SYSTEM

An expert overview of America’s dysfunctional health care system and good ideas for fixing it.

Since the Covid-19 pandemic started, the U.S. has suffered the most deaths of any nation, with a far higher percentage among the elderly, racial minorities, and the poor. In passionate but lucid, fact-based polemic, Nash, a professor of health policy, and journalist Wohlforth point out the primary cause of this dire situation: a wildly expensive, technology-obsessed, fee-for-service system that emphasizes treating disease over prevention, public health, and addressing the socio-economic determinants of health. In the first half of the book, the authors recount the failures that accompanied a pandemic in which “America performed “uniquely badly.” It turns out that not all the failures were Donald Trump’s fault. Vital institutions, especially the Centers for Disease Control and Prevention and the Food and Drug Administration, performed poorly, and America’s fiercely entrepreneurial medical culture continues to veto lifesaving decisions on cost-effective grounds—even though nearly everyone agrees that these are sometimes wrong. Studies prove that giving the poor enough income, housing, and nutritious food to lift them out of poverty is cheaper than treating the medical and social consequences of that poverty. The pandemic was a gold mine for insurance companies because patients stayed away from doctors in droves but continued to pay premiums. Many rewarded their stockholders, but some purchased hospitals to become “payviders.” This is simply a single-payer system on a local scale, where the providers become responsible for a patient’s overall health rather than delivering episodic care and then sending a bill. Readers will squirm as they learn how American doctors are educated but feel some relief as they read about how medical schools are increasingly teaching compassion and communication and a willingness “to tackle issues not traditionally thought of as a role of a health care provider.” In the second half of the book, Nash and Wohlforth deliver an intelligent prescription for reform; thankfully, many of its features are already in progress.

Convincing advice for reform that should persuade the persuadable.