This American Life: The Health Care System Delivers What it is Designed to Deliver

Public radio's "This American Life" spent an hour this weekend explaining underlying motivations that drive the health care system (and its costs).  The show includes a dining room conversation with John Wennberg, who pioneered small area variation analysis and whose institute at Dartmouth has shown that areas with higher costs have lower quality.  There are also post-malpractice reflections of a resident who offered informed consent rather than simply ordering a PSA, a screening test for prostate cancer, and an emergency department physician's frustration at pushy parents' demanding inappropriate and potentially dangerous tests.  The show discusses the BCBS California- Sutter showdown -- showing that insurance plans often have less leverage than on might think.   A former insurance company executive who was denied his request to move closer to home for rehab after a severe head injury concludes that this was the "right thing to do," but notes how different this is viewing it from the patient perspective and the health plan perspective.  

The show is available for download or listening at this link.  Next week's TAL is about moral hazard -  how insurance coverage by "other people's money" increases cost.