Why is American health care so expensive?

I have recently become aware that some people are mistakenly getting suspicious that Covid 19 death counts are an overestimate. That is probably because the numbers are awful and very hard to visualize. Nearly 110,000 deaths have been documented so far in the US, which is undoubtedly significantly below the actual number who have died from the disease (see my previous blog on the subject, from very early on in the pandemic.) Our freshman US representative in Idaho, who serves a dark red district of a very conservative state, recently wrote a letter to the CDC concerned that the guidance they have given regarding filling in death certificates will lead to a falsely elevated number of people who have died of the disease. I just wrote Mr. Fulcher a letter explaining why this is wrong. "I saw your letter in your recent email encouraging the CDC to count Covid deaths accurately. I think you may not know some of the nitty gritty of documenting cause of death from a doctor's standpoi

I am not especially qualified to write on the subject of racism or the militarization of policing or how the criminal justice system perpetuates poverty and loss of opportunity based on race. I am white, grew up in predominantly white neighborhoods and have always had certain expectations based on those privileges. Like most people I have my own story flavored by my own challenges. None of these challenges are based on race. I have watched from my safe community where police generally act like good people. (Obviously this is from my standpoint which may not represent everyone's experience.) As a doctor I have cared for police refugees from big cities, retired officers whose experiences of police culture drove them away and marked their personalities. I have enough connection with people on the receiving end of the criminal justice system in other communities that I am not entirely ignorant, but my experience is definitely limited. So in this time of Covid 19 and now widespread demo

It is 2 weeks since Governor Brad Little of Idaho issued a statewide "stay at home" order and about 3 weeks since my little town has been staying at home because of an earlier mayor's order. The whole US has been increasingly moving toward self quarantining. People throughout the world are being asked to avoid sharing space and sharing germs with others. Buying and selling and traveling aren't happening much. There is very little going to school, receiving non-essential services, partying, touching or breathing on people outside of our immediate biological or chosen families. Some people are getting bored. Many are feeling challenged by having to do things that aren't normal for them, things like cooking, cleaning, childcare. Many of the things that filled our days are just not happening. There is a whole lot of quiet. The creativity that is happening in the absence of whatever it was we used to do is pretty stupendous . People are writing for each other an

This morning the total number of deaths in the US from Covid-19 was said to be 994. That sounds kind of low, since influenza has already killed 30,000 this season. In the places where coronavirus has hit hard, it's much worse than the flu, in New York and New Orleans for instance. People are much sicker and the whole healthcare system, including emergency medical services, is stressed to breaking. We know that coronavirus is more severe and more contagious and more deadly than the flu by at least a factor of 10. Why are the numbers of deaths presently so low? The thing that nobody is talking about with regard to Covid deaths is that our data about who has died is going to lag by weeks, months or even years and will probably fail to represent all of the deaths for which Covid is responsible. Why is this? People are dying at home of Covid. How do I know this? Because 25% of people die in their own homes. People with symptoms of coronavirus are being encouraged to stay at hom

When we are all trying to avoid deadly spread of coronavirus infections, can we still have sex ? This is a GREAT question. Luckily the New York City department of health has answered this and many more questions you may hesitate to ask in their very complete and unabashed 2 page primer on the subject. Please follow the link. It is a brilliant document leaving just enough to the imagination. The most controversial and absolutely true statement they make is that "You are your safest sex partner."   Sex is the most physically intimate activity that most people engage in. Coronavirus is transmitted when virus from one person's respiratory tract (usually lungs, mouth or nose) finds its way to another person's respiratory tract where it infects vulnerable cells. Not all cells are vulnerable. Coronavirus is found in certain other body fluids but it is less practical for the viruses in, say, stool or tears to be involved in transmitting infection. But sex betw

Idaho has 42 cases of Covid-19 as of this morning. It feels like nothing, but that's because very few people are being tested and we are on the leading edge of the exponential growth curve. Some of us feel bad for feeling happy because these are serious times, some people feel sad in expectation of feeling sad in the future and others are just scared. It feels a little like a snow day, though, and we are knee deep in possibilities. Young people who never cook are learning to cook. People are doing crafts and hunkering down. I've heard from friends who I'd lost touch with. Much of my day is eaten up by learning more of what's known and what's known today may be wrong tomorrow. Things you should know which are likely to be true: The coronavirus has a median incubation period of just over 5 days and nearly everyone who gets it will get it within 12 days of exposure. This is from China's data, reported in the Annals of Internal Medicine.  Symptoms