Since the Acquired podcast was so heavily recommended by John Gruber and Ben Thompson on Dithering, I thought I would give it a try. Half an hour into an almost four-hour episode about Epic EMR, I am not impressed.
The style is in the uncanny valley between spontaneous and fully scripted, where the two co-hosts simulate a dialogue in the style of NotebookLM. I could actually tolerate that part: “The Rest Is History” podcast has the same shtick and I’ve listened to quite a few episodes. What I can’t stand is sloppiness about facts (ahem), and this is what one of the hosts uttered as an introduction to why medical records have become so important:
The important thing to realize from all this is that the vast majority of patients do not feel the cost of their healthcare directly in the United States. Those costs are so laundered through private insurance companies and Medicare and Medicaid, that most people think about any given health encounter as being paid for by someone else, by a part of some system.
If you’re trying to unpack how did our healthcare become 18% of GDP versus 11% of the UK GDP or a staggering 6% of Singapore’s GDP, albeit at a much smaller scale, why are we 18%? A big thing you have to understand is psychologically every healthcare encounter is that the system is paying for it. I’m paying into the system, the system is paying for it, but what does it cost? What do I actually pay? It’s a big abstraction.
This is, of course, hogwash. Citizen of the UK and Singapore are even further removed from knowing how much their health care costs — Singapore has a mandatory government-funded “base” coverage with voluntary private coverage on top, and the UK of course has the NHS which is funded straight from the budget — so anyone trying to blame the American healthcare disaster on patients, the implication being that they are spending money like drunken sailors because they don’t know what anything costs, is trying to pull wool over your eyes.
I would also push back strongly against the first paragraph. No one — underlined, bold, in all caps NO ONE — in the United States of America things that their health encounter is being paid by someone else, because the deductibles are high, so are the co-pays, the insurance premiums are staring at your from the pay stub, and at the end of each encounter with the “health” “care” “system” comes the Explanation of Benefits. I mean, who is this podcast even for?
Oh.
“Acquired tells the definitive history & strategy of the world’s greatest companies” says the home page, not realizing that there is a difference between history and hagiography. These guys are doing the latter, to much back-patting from the buy, borrow, die class which eats that stuff up. I’ll pass.