2060

Book Title: 2060

Author: Richard Young, MD

Publication Details: Wild Lark Books, 2023, 373 pp., $19.99, paperback

2060 seeks to realistically portray the dystopian future of the American health care system if current trends remain unchecked. Protagonist Willis Smith is a Gen Z data analyst with mountains of debt, both from student loans and medical bills; he is working his first full-time job for IntegraHealth, one of the top five health care conglomerates in the country. Willis is tasked with being lead analyst in the race to find the first survivor of four metastatic cancers—a competition put forth by the government as part of the ZapCancer program. The victor will claim the more than trillion-dollar Medicare Advantage contract, guaranteeing the company’s financial success.

In his search, Willis uncovers all manners of graft and fraud in a company that values profits over patients; but he also becomes entangled with a family seeking to do what is right for its community. He is forced to examine the biases and assumptions that have shaped his notion of health as well as its cost, both to the individual and to Americans as a whole.

The characters are well-developed and add to the believability of the story. While shortsighted, Willis is a lovable character who struggles with balancing the desire for success at work and doing what he knows is right. Financially he knows he cannot afford to lose his job but becomes increasingly uncomfortable with the tasks he is assigned. His boss, as expected, is a narcissistic ogre who cares only about increasing his own power. Willis meets his girlfriend, the daughter of Vietnamese immigrants, while rescuing her from racist thugs who blame immigrants for all that is wrong in the world. She is both deeply committed to family and a realist, and she encourages Willis to continue to question the values of those in charge. Together, these characters and others make for a gripping story that is difficult to put down.

While the novel is entertaining in and of itself, its real value is in highlighting the inequity and unaffordability of our current health care system and the impact this has on school budgets, public employee pension funds, retirement ages, transportation infrastructure, and state and national budgets. And this, Richard Young, MD, explains, was his purpose in authoring this novel. In his powerful afterword, Dr Young proposes that Americans are emotionally incapable of facing the real issues that need to be addressed to enact reforms, “expecting that the healthcare system will make their bodies perfect and that they will have ample energy and no pain until they die at some age over one hundred” (p. 350). By creating empathy for future Americans who will be forced to deal with the aftermath of our current excesses in health care expenditure, the author hopes that 2060 will engender discussion regarding societal values surrounding health and prompt realistic decisions regarding cost in ways that his prior nonfiction book of 2012, American Health$care: How the Healthcare Industry’s Scare Tactics Have Screwed up Our Economy, and our Future, did not. ¹

Dr Young describes health care in other developed countries that provides better outcomes for substantially lower costs and makes the case that the societal values make the difference more so than the method of care delivery. While we in the United States avoid discussing limiting or eliminating expensive services that are marginally beneficial, other countries already do so. There, conversations start by acknowledging that resources are limited and entail determining how best to use what is available. Quality of life is valued more than quantity of life, as opposed to the typical American belief that any treatment that might be beneficial should be offered regardless of the associated cost, the degree of benefit, or the likelihood of associated suffering. Finally, for naysayers who might accuse Dr Young of painting an overly bleak outlook, he includes an appendix that details how he arrived at his predictions of what life might be like in 2060, lending even greater urgency to the need to address these critical issues.

Overall, this was a thoroughly enjoyable novel that alone would have been worth the read. The afterword and appendix made it even more thought-provoking, clearly making the case that something must change, or this may indeed be the future we are facing. I would recommend 2060 to anyone with an interest in health equity and/or health care finance. It would also be an excellent choice for a book club of physicians, residents, and students, and for interested health care executives. I share Dr Young’s hope that this is a topic that we will begin to address as a country.