Stephen Dubner

They've gotten sludged up by those long legal disclaimers that some people attach to their every email signature. So what could have been a nice, clean email thread becomes a sludge forest that you have to hunt through in order to find the actual message. And now try doing this on a screen the size of your palm.

They've gotten sludged up by those long legal disclaimers that some people attach to their every email signature. So what could have been a nice, clean email thread becomes a sludge forest that you have to hunt through in order to find the actual message. And now try doing this on a screen the size of your palm.

They've gotten sludged up by those long legal disclaimers that some people attach to their every email signature. So what could have been a nice, clean email thread becomes a sludge forest that you have to hunt through in order to find the actual message. And now try doing this on a screen the size of your palm.

This kind of sludge is not only frustrating, it's deeply inefficient and costly, and it leads to mistakes. There is, of course, one way to fight sludge by hiring someone to process it for you. As some academic researchers have pointed out, sludge favors the powerful, the wealthy and the healthy.

This kind of sludge is not only frustrating, it's deeply inefficient and costly, and it leads to mistakes. There is, of course, one way to fight sludge by hiring someone to process it for you. As some academic researchers have pointed out, sludge favors the powerful, the wealthy and the healthy.

This kind of sludge is not only frustrating, it's deeply inefficient and costly, and it leads to mistakes. There is, of course, one way to fight sludge by hiring someone to process it for you. As some academic researchers have pointed out, sludge favors the powerful, the wealthy and the healthy.

But if you don't have the ability or the resources or the time to process all that sludge, you are at a big disadvantage. So getting back to the question I raised a minute ago, how can it be that we spend so much money on health care and don't get the best health outcomes? I would argue that sludge is probably a major contributor.

But if you don't have the ability or the resources or the time to process all that sludge, you are at a big disadvantage. So getting back to the question I raised a minute ago, how can it be that we spend so much money on health care and don't get the best health outcomes? I would argue that sludge is probably a major contributor.

But if you don't have the ability or the resources or the time to process all that sludge, you are at a big disadvantage. So getting back to the question I raised a minute ago, how can it be that we spend so much money on health care and don't get the best health outcomes? I would argue that sludge is probably a major contributor.

For instance, there is research showing that a huge share of older adults struggle to use medical documents like forms or charts. So what good is a world class system of clinical and research expertise if people can't properly access that system?

For instance, there is research showing that a huge share of older adults struggle to use medical documents like forms or charts. So what good is a world class system of clinical and research expertise if people can't properly access that system?

For instance, there is research showing that a huge share of older adults struggle to use medical documents like forms or charts. So what good is a world class system of clinical and research expertise if people can't properly access that system?

I went back to the economist Ben Handel and asked him how much he thinks sludge contributes to our very high cost of health care and our less than great outcomes.

I went back to the economist Ben Handel and asked him how much he thinks sludge contributes to our very high cost of health care and our less than great outcomes.

I went back to the economist Ben Handel and asked him how much he thinks sludge contributes to our very high cost of health care and our less than great outcomes.

Let's back up for a minute here to see where Handel is coming from. His interest in healthcare economics goes back to when he was getting his Ph.D. from Northwestern University. He managed to get his hands on a very large and detailed set of insurance data.

Let's back up for a minute here to see where Handel is coming from. His interest in healthcare economics goes back to when he was getting his Ph.D. from Northwestern University. He managed to get his hands on a very large and detailed set of insurance data.

Let's back up for a minute here to see where Handel is coming from. His interest in healthcare economics goes back to when he was getting his Ph.D. from Northwestern University. He managed to get his hands on a very large and detailed set of insurance data.

Handel found that just about every health plan offered to employees included what he calls a dominated option. That's a phrase that comes from game theory. And in this case, it means an option that is objectively worse than every other option. Theoretically, firms should not offer this option and no employees should choose it. But they did choose. And they do.

Handel found that just about every health plan offered to employees included what he calls a dominated option. That's a phrase that comes from game theory. And in this case, it means an option that is objectively worse than every other option. Theoretically, firms should not offer this option and no employees should choose it. But they did choose. And they do.