You’ve heard EconTalk host Russ Roberts argue that the central problem in American health care is that doctors get paid to do stuff to us, rather than take care of us. In this episode, Roberts welcomes physician and author Vivian Lee to talk about her new book, The Long Fix, to continue this conversation.

Roberts and Lee discuss the rising cost of health care, the trend of over-treatment and diagnosis at the expense of better health, and sources of optimism for the future of health care, including possible “silver linings” to the COVID-19 pandemic. Health care, asserts Lee, is “flying into the headwinds of capitalism,” and unless the incentives inherent in the system can be changed, there is little chance for relief.

After listening to this episode, we hope you’ll use the questions below to start your own conversation, either on- or offline. You might be interested in looking back at the many previous EconTalk episodes on health care for even more conversational inspiration.



1- We’re used to Roberts saying that “we” don’t pay for our health care. Lee disagrees. How does Lee explain her position? How does her catering analogy contribute to her explanation?


2- What is the “Chargemaster,” and how does this often result in differential prices for different kinds of patients? In what ways does Lee believe that standardizing the Chargemaster could have a big effect on the price we pay for health care? How should this standardization be accomplished?


3- Roberts asks Lee for her sources of optimism, and she enthusiastically describes the Medicare Advantage programs. What is it she likes about them? How do they change doctors’s incentives positively?


4- What are some of the disruptive forces in primary care discussed in this episode that strike you as promising? Lee says,”What’s going to be really interesting in the next few years is the degree to which this kind of mindset can extend to secondary, tertiary care, to hospitalizations, and to rehabilitation. That’s really where more of the dollars are spent right now.” What are some of the challenges in these areas? To what extent do you think COVID-19 will inspire innovation in health care?


5- Lee’s professional focus now is on creating a “learning health system?” What does she mean when she says of the future, “We are going to pay for better health. We’re not going to be fee-for-service anymore. The days of fee-for-service are numbered. Let the tailwinds of capitalism push this forward.” To what extent do you share Lee’s optimism?