Why is American health care so expensive?

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

I've been thinking about police violence, crime, the criminal justice system and its horrors, racial barriers to success, fear and racism in general. It's been a busy few days as I've tried to educate myself on problems that have been impacting black and brown people for a long time. The video clips that are now circulating are bringing the reality of police violence and disrespect to even people like me, who are protected from that reality by accidents of birth and the privilege of living in a peaceful place.  I've been able to generalize those visuals a bit. I have also listened to the stories of my formerly incarcerated patients. The experience of people in poverty, especially when non-white or vulnerable due to homelessness or mental illness, is that police are to be feared. We are now seeing people die because of interacting with police, but that isn't even the biggest problem. There are far more people who are injured physically, mentally or through inappropri

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