“This American Life” on Why the Healthcare System is Out of Control

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.


  1. menoalittle on October 21, 2009 at 8:14 pm


    It is intellectually rewarding to listen to these pieces that lend architectural analysis for the collapsing edifice of providing medical care.

    Troublesome as the current problems are, the halfway technology (described by the late Lewis Thomas, MD) known as health information technology yields dreams and a direction on a circuitous costly detour that will not fix the foundation of what is wrong.

    Early returns on HHIT (halfway health information technology), as you have seen, demonstrated further deterioration of care. This is exemplified by the experiences in the UK and Australia, and to some extent, in Canada.

    Consider the redirection of the multiples of billions of dollars belonging to the US citizens from HHIT to educated human resources responding to the reports you reference and there may be benevolent evolution of medical care processes.

    Best regards,


  2. oregondoc on December 14, 2009 at 6:25 pm

    I enjoyed “Other People’s Money”—the title of the episode form This American Life. I was especially floored when the dermatologist was excused from knowing the costs of medications but seemed willing to give out coupons. To me this highlighted a major problem in healthcare. As a hospitalist–I look at the 4$ list at Walmart. I prescribe many drugs and I TRY to be aware of the costs for my patients. The dermatologist that they interviewed seemed influenced by drug companies and had absolutely no care for the costs of drugs– not to mention that they usually have a lot smaller list of drugs to choose from……….

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