Why is American health care so expensive?

It was a beautiful early spring day. I was working in a little patch of native plants, clearing away some pine needles and pulling dandelions. It was pretty much perfect weed picking soil, moist with spring rains but not muddy. In order to avoid stepping on the plants, I grabbed a vertical handrail support and swung myself up to the sidewalk and directly into the end of the rail. I felt and heard my rib cage crunch. Ow. When I could breathe I found that, although it was painful, I could still do some things around the yard. I was pretty sure that it would get worse, so I worked a bit and then rested inside. It did get worse. Daily it became more painful so that on day 3 almost anything I did was excruciating. Twisting, leaning over, taking a deep breath, yawning, sneezing, coughing and taking a shower. Lying down in bed was a trick. As the song goes, the rib bone's connected to the everything else bone. There was no really pain free way to lie down, though there were positions that

Happy 2022--let it be filled with good things. And on that note, I wrote a poem. (After reading Manifesto of Encouragement by Danielle LaPorte) Even now   All is not lost-- even now your frozen pipes are melting. Cells in your body are repairing what is broken and injured. T cells and B cells are working together to keep the bacteria and viruses in balance with the cells that make up what you think of as you. Macrophages are cleaning up the mess. Thanks for your service. That cancer cell? Nope. Sorry buster, not today. Natural killer cells. You don’t even pay them. Certain very bad jokes aren’t being told. The last person to tell them has just died. He didn’t use the internet so the ripples of their passage only exist in the vibrations of rocks. That thing you did that still makes you cringe? Even now the last person, other than you, who knew about it has just forgotten. Just yesterday you learned a new thing and at this very moment you remembered what it was. P

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