Why is American health care so expensive?

I've noticed that when I'm at work, I generally love my patients. I may have complaints about them, wish they would behave differently, get frustrated with their choices, but I do feel a warm connection with them. (OK, there are people/patients who I find I am violently allergic to, but they are rare.) I work in an area which votes differently than I do, and I don't necessarily agree with my patients, but I have their backs and want what's best for them.  I don't necessarily feel that way about my fellow Americans. As a group many of them seem to act in ignorant, short sighted and often hateful ways. But when I meet them in a stuffy little office, I like them and on the important stuff, we usually see eye to eye. Why is that? I think I'm being hacked. My brain, that is. I think that there may be a concerted effort going on to make me feel like I'm not a powerful and loving part of a valued whole. It seems like what I read and what I'm exposed to in news

  I've been writing a few things about the climate at the other place, https://doctorjanicesblog.org/. Just thought I'd mirror those here. Since I last mentioned the climate in this blog, there have been catastrophic floods in the Northwest and record high temperatures in the east coast. The area of South Sudan where I have spent time teaching ultrasound and helping out a bit in a hospital serving internally displaced people remains flooded. For most of a year now there have been no safe places to sleep in the land near Old Fangak, other than those protected by mud dikes and sandbags. So not safe, actually, at all. Gardens are flooded. Roads are rivers. I see photos and I don't recognize the place. I can only barely imagine what it must be like to be trying to live there. Flooding is normal in the rainy season, but never persisting through the dry season like this. The climate continues to change and the results are unpredictable and often tragic. I have been writing a bit

What I do most and what I do best is medicine. Healthcare. So I began to write (this blog was created in 2009) as I saw the compassionate practice of medicine being threatened by a system that has perverse incentives, causing it to be crazily expensive and ever more inadequate.  There was a great deal of debate surrounding equitable payment for medical care leading up to passage of the affordable care act. Much of the debate was uninformed, so I wrote things, from the point of view of a real doctor working with real patients in a variety of pretty normal places. I added some data to the roiling pot of data that is the internet. Threw virtual messages in bottles into the virtual ocean. There are 353 posts, around 2700 visits per month, a few more than 624,000 views over the life of the blog. Maybe some of those views influenced people in ways that made medicine more compassionate, more nuanced, equitable, effective and less ignorant, expensive and daft. When Covid hit, there was so much

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting it for tr

I just heard a talk by Kimberly Manning MD,  Associate Professor of Medicine as well as the Associate Vice Chair of Diversity, Equity, and Inclusion at   Emory University School of Medicine, department of Medicine at the American College of Physician's virtual yearly meeting. She gave one of the plenary addresses and hers was called "Broadening your life lens, the case for diversity." I almost didn't watch it because I attend this meeting for the concentrated information on how to take care of patients with certain conditions that I get from talks with names like "Pearls for the management of insomnia not to miss." I thought that this was a talk for other people, and since I had studied this subject, maybe not for me. But I watched it anyway. It was great.  Dr. Manning is a full professor at her institution, which makes her very special. She told us that 0.7% full professors of medicine are black women. 25% of full professors are women and Black women make u

  In early March 2020 I began to write posts about Covid 19. There were few places that people could get good information that addressed the big picture and made it possible to understand what was happening. It seemed like I should write some things that made sense of it all. I wanted to write about what I knew, or thought I knew was true, since there was so much misinformation circulating. So, during the second half of March, I wrote nine blog posts. What did I say and was it true? In my very first  post I talked about how everything would change . How we would burn less carbon, we would learn how not to travel for work, how we would learn not to transmit other viruses, like influenza. That was all true . The demand for gasoline was so low that oil prices dropped to a fraction of the cost of production. Planes didn't fly much. We haven't had a flu season to speak about due to infection control measures. I said we should have massively expanded testing because it would allow p

In my present job in a low cost health clinic I don't see much acute Covid. Patients in the infectious stage of the coronavirus are dangerous to everyone they breathe on and potentially infectious virus particles can survive on surfaces in clinic, putting staff and other patients at risk. We see most patients who are still infectious in their cars or we arrange video or telephone based visits. If they are very sick, they need to go to the hospital. Sometimes I feel guilty that I am not taking care of these very sick patients, but that's not my role right now.  The people I do end up seeing are patients who have had Covid, should have recovered, but are still sick. There are many of these people. These are young people, in their 20's maybe, who got sick, tested positive, took 2 weeks off of work, but then can't function normally when they try to go back. They are older people, often with other chronic diseases, who were doing fine but now can't take care of their hou