Why is American health care so expensive?

Do patients actually know what they are getting from their doctors, and do they want it? As I understand it, most patients want from their doctors primarily relief from suffering. And if they can't get relief from suffering, they would like to be heard and they would like to come closer to understanding the cause of their suffering. When we prescribe cream for a rash, antibiotics for pneumonia or set a broken bone we are really right on the money. When we counsel and comfort we are doing the job we were hired for. When we get into the business of prevention, we are on a bit more shaky ground. Much of our energy is spent haranguing, wheedling, threatening and assigning tasks. This is all in the service of preventing suffering, which isn't a bad goal when you think about it. We nag patients to take cholesterol pills, we assign them to go to obscure destinations to see specialists, we convince them to have painful and undignified tests like colonoscopies and mammograms. Many pat...

As people age, their kidney function gradually goes down, usually keeping pace with overall needs. In people with longstanding diabetes or high blood pressure, though, sometimes the kidneys fail before the rest of the body does. In this situation, various toxins build up in the blood and such a person gradually becomes weaker and eventually dies. Enter kidney dialysis. With a machine that runs the blood through a filter, much as the kidney is a filter, the toxins can be removed from the blood. Unfortunately all of the blood needs to be run through that filter, which is somewhat tricky, and it takes about 4 hours, and needs to be done about 3 times a week. This is barely tolerable, but better than dying, usually, if you are pretty young, or only have to do it for awhile, as you wait to receive a kidney transplant. If you are very old, though, dialysis is physically stressful. The heart has to tolerate the movement of blood out of and back into the body, and all of the organs...

Last night I participated as a member of a panel speaking to medical students about issues relating to health care reform. Next to me was a respectable Blue Cross executive from the state capital, next to him a health care economist from the university and then two of my doctor colleagues. Our first starter upper question from the gathered masses was what we thought was the major problem with health care in America. The insurance guy and the economist said that people don’t take good care of themselves and so are in lousy health, and that they ought to take more personal responsibility for being healthier. This is what I keep hearing from Washington DC folks not in medicine, and although it is a truism, is it actually true? Clearly, from the standpoint of bang for the buck, health and happiness and overall simplicity of delivery, the prevention of illness by avoiding overeating, drinking, smoking and drug addiction is powerfully attractive. Add to that physical activity with all of the...

Hooray for Hawaii! Apparently they have managed to get employers to cover just about everyone with adequate health insurance and their health insurance costs and other markers of health care efficiency are marvelous. Could it be the sea air? http://www.nytimes.com/2009/10/17/health/policy/17hawaii.html?em So I am brought back to the dilemma that keeps popping up in the health care debate. Can we submit the business of caring for peoples’ health and diseases to market forces and bring down costs? As long as health insurance continues to protect people from exposure to the real costs of things, I don’t see market forces adequately coming into play. Only if health insurance companies actually acted like consumers would that really happen. Why are medications so incredibly and jaw droppingly expensive? Especially ones for diseases like cancer and transplants and severe diseases? Because people who have those conditions are ALWAYS insured, or else they die, and are not part of the equ...

A bill has passed the senate finance committee, with "bipartisan support", which means one Republican voted for it. The bill is only a tiny part of a health care reform package that will eventually by voted on in the house and the senate. This tiny piece provides for more affordable universal health insurance, which is good, and will make those of us who have to negotiate for health insurance breathe a little easier. It would put an end to really heinous insurance company antics, such as canceling policies because people are sick. It allows for competition across state lines, stand alone dental insurance, expansion of medicaid and funding help for consumer driven health insurance options. So it is good. It is not exactly what we need, but it does address some of the issues. What we really need is still a radical reduction in costs. Although, as a health care consumer, I welcome anything that will bring some relief to those of us who suffer through having to pay for health i...

Does every American citizen have a right to health care? How about "affordable health care?" It's tricky, this question of rights. I would like everyone to have enough food, but everyone doesn't have a right to enough food. Or enough sleep. Or love... Soon after 9/11, Mayor Giuliani of New York City said that every American has a right to freedom from fear. No, I think, they do not. Traditionally, as a country, we have made laws that prohibit the government taking away our individual self determination, and placing strict controls on the ways in which our self determination can be restricted in cases of law breaking or conflict. We have also developed institutions by which we care for each others' needs, guarding against letting those who are vulnerable die of poverty. As a health care provider, I balk at the idea that every citizen has a right to what I produce. It's kind of like telling a dairy owner that everyone has a right to cheese. Nevertheless, as a...