Why is American health care so expensive?

I practice primary care internal medicine in a group that consists of a few family practitioners, a few nurse practitioners and 7 internists, two of whom are also specialists. (An internist is defined as a physician who specializes in the detection, prevention and treatment of illnesses in adults.)  My office is across the state line from our primary office and has consisted of 3 internists and sometimes a nurse practitioner. I see patients in the office 4 days a week and also take care of  hospitalized patients.  The hospital is a very good but small (25 bed) facility, with cool features like an MRI machine, fully staffed emergency department and rooftop helicopter pad for transferring very sick patients to larger centers, and is a 20 second walk from my office. I think, right now, that mine is about the best job a person could have. In two weeks, the third internist in my small office will be moving to another state.  He has been very productive and has been doin...

Amount of pressure

A hot topic in medicine is the "impaired physician". There was a whole series in the throw-away journal Pain Medicine written by a doctor who spectacularly screwed his life up by getting addicted to opiate pain medications, then overprescribing those same drugs to patients and defrauding Medicare and Medicaid by charging for procedures that he didn't do. He proceeded to run off to various foreign countries where he managed to keep himself fed and housed until finally returning to the US to serve his time and probably not practice medicine. The articles he wrote were luridly exciting, definitely not in the category of "there but for the grace of God go I." Most of us in medicine have had contact with a colleague who has some kind of a substance abuse problem. I personally have had 3 colleagues with whom I worked closely who had trouble with both drugs and alcohol to the extent that their work was affected and they had to take time off, do a treatment program a...