If you can spare 2 hours, do yourself a favor by listening to the two-part healthcare series on NPR’s extraordinary show, This American Life.
By using examples that are memorable for their simplicity and lack of hyperbole, the series (the episodes are here and here) does a superb job illustrating how we got into the predicament we’re in, and how hard it is will be to extricate ourselves from it. Although the dominant theme mirrors that of the Expensive Lunch Club I discussed in July, the vignettes and interviews bring the problems to life: what we can learn about healthcare insurance by examining the emerging market in pet insurance (yes, you too can treat your pet hedgehog with antipsychotics); the acne medicine whose generic version costs $500 less than the brand version (and the cat-and-mouse games Big Pharma plays to get patients to favor the latter); the accidental nature of today’s incomprehensible healthcare marketplace (it turned on a seemingly trivial ruling by a nameless Eisenhower-era IRS bureaucrat that employer-based health insurance shouldn’t be taxed); an interview with Jack Wennberg about his early experience with getting docs to swallow the Dartmouth Atlas variations data; the daily travails of an ER physician trying to convince angry family members that their loved ones really don’t need those unnecessary CT scans.
Like all the segments on This American Life, Ira Glass’s nasal intonations, the soothing background music, and the low key, painterly presentations can easily lull you into missing the fact that this is hard-hitting journalism of the highest order. The series presents a fascinating, illuminating, and incredibly scary story, because – if you’re like me – you finish it realizing that few of the players (yes, even pharma or insurance execs) are venal. At the end of the second episode, Princeton economist Uwe Reinhardt recalls the time he told insurance leaders, “You’re all good guys… but you do some awfully mean things, and you do them because you’re in a structure that makes you do these things.” Substitute the words “irresponsible” or “unaffordable” or “crazy” for Uwe’s “mean” and you can use his line to describe every player in the healthcare world: doctors, hospitals, vendors, training programs… and yes, patients.
When you find yourself talking to someone about healthcare reform, or insurance, or why things cost so damn much, and you get to the invariable, “I just don’t get it” stage, this is the story to send their way.