US healthcare sludge = hundreds of billions/year
Richard Thaler estimated the sludge cost of the US medical system alone is in the hundreds of billions of dollars per year.
Where this was said
Types of Sludge: Incompetent, Accidental, and Intentional
At 12:32 · chapter starts 9:30
Thaler begins with what he calls 'inadvertent and/or incompetent sludge' — design failures like Norman doors, where the physical affordance of a door handle tells your brain to pull when you need to push. These aren't malicious, just thoughtless, and the architects responsible deserve 'a special place in hell.' He then pivots to the unsubscribe trap: where one click signs you up for a service but cancellation requires a phone call, a wait, and a sales pitch. That, Thaler says, is clearly intentional. He cites gyms during COVID that required members to physically enter a closed facility to cancel their membership — nobody designs that innocently. He notes he has personally tried to convince subscription companies to stop these practices, and been told bluntly that it would cost too much. Thaler's rough estimate: healthcare sludge alone costs the US hundreds of billions annually, though almost none of it is formally measured.
Gyms Made Members Come In to Quit During COVID
During COVID lockdowns, some gyms required members to physically show up at a closed gym to cancel their membership. Richard Thaler's verdict: nobody designs that innocently — it is pure, strategic sludge.
US Healthcare Sludge Costs Hundreds of Billions Per Year
Nobody has a precise figure for the cost of healthcare sludge, but Richard Thaler puts it in the hundreds of billions per year for the US alone. The problem is that so much of it is consumed time — invisible on any balance sheet.
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