Why is American health care so expensive?

The joy of locum tenens work is that I can, actually, take a vacation. I have been working a lot, and so now I am going to be away from anything that begets blogs about medical care for most of a month. I will be singing polyphonic music in the Republic of Georgia and canoeing, briefly, in the Skagit River. I will miss the doctoring, but only a little bit. I will then return and jump right back in, with both feet. I might write another blog while I am in foreign lands, but probably not, so I'm guessing I'll be checking in again sometime in early October.

It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this? In 1847 the AMA published its first "code of medical ethics" which covered many subjects and, though short, is dense and diatribe-like. It seemed to me, when I read through it, that it was mainly concerned with discouraging various forms of quackery, which was rampant in the relatively unregulated environment of the early 19th century in the United States. We physicians were enjoined to "unite tenderness with firmness and condescension with authority" and our patients were reminded that they needed to do what we told them and not fuss and argue with us. Physicians were required to be always available to sick patients, to get consultation when necessary, to treat those who could not afford to pay. In turn, patients were told...