Why is American health care so expensive?

Today I took my boards, for the first time since 1989. It wasn't bad. I can't write anything substantial about the content because I swore on a stack of Harrison's Text Books of Internal Medicine that I would not, "copy, reproduce, adapt, disclose, solicit, use, review, consult or transmit ABIM examinations, in whole or in part, before or after taking my examination, by any means now known or hearafter invented."  Also, I "further acknowledge that disclosure of any other use of ABIM examination content constitutes professional misconduct and may expose me to criminal as well as civil liability." My lips are sealed. I scheduled the test through the ABIM site on the computer and had to travel about 2 hours to get to a testing office since I don't live near a big city. The test began at 8 AM, and was limited to 6 hours to answer 3 blocks of questions and about an hour and a half of break time that could be taken between these blocks. The office had ab...

In the year 1986 I loved neurology so much that I arranged to spend 3 months in England watching the most godlike neurologists on earth practice their art at the National Hospital for Neurological Diseases in Queen's Square, London. People came from all over the world to be diagnosed by grand old men (there may have been women but I didn't see them) of nearly magical prowess who also taught medical students. They knew what people had, mostly by talking to them and watching them, doing neurological examinations, and less importantly by doing blood tests and imaging procedures. I was a sponge and would have gone into Neurology as a specialty except that the rest of medicine was also really interesting. Now I am reading the MKSAP booklet on neurology as I continue to study for my internal medicine board exam, 90 pages of digested and compacted information about the brain in health and disease, treatments, recommendations for evaluation of symptoms, and although I have been pract...

Really nothing is wrong with still studying. I'm still enjoying it and absorbing some non-negligible percentage of what I'm reading. There is just a tremendous amount of stuff that has become commonly held truth since I last took this exam. But as I study, which is still following the general form of reading a multiple choice question from the MKSAP (American College of Physicians Medical Knowledge Self Assessment Program) then reviewing various sources on anything that I don't feel totally confident about, some of the patient vignettes demonstrate a lack of attention to the big picture. The multiple choice questions are all case presentations, which is good since it keeps me engaged. Here are a few of the more disturbing ones out of the hematology/oncology section which I am working on now, reworded, simplified beyond recognition. 1. A 70 year old severely demented man, living at home with his wife, very thin, presents in bad shape with respiratory failure and pneumo...