Why is American health care so expensive?

There are many ways to visit exotic destinations, including cruises, tours, adventure travel, business related meetings and just plain going there. I always thought it would be most interesting to visit a place and practice medicine, since it would give me the opportunity to meet interesting people, do interesting things and maybe actually help. I first went overseas as a doctor about 23 years ago after finishing my medical residency. I traveled north from Bangkok to Chiang Mai where I found my way to the McKean leprosy hospital. There I spent a week rounding with the American physician who was the medical director, surgeon and primary doctor for all of the leprosy patients. There were also visiting dentists from Germany and other people who helped in various ways, including carrying on a religious mission for the Episcopal Church. It was one of the most memorable weeks of my life and flavored my ideas about medicine for the decades I have practiced since then. I have looked for wa...

I have just pretty much recovered from jet lag and my anti-malarial drug induced dysphoria (I will attest to the fact that Mefloquine does have side effects) and am excited to tell the story of a project that I got to be part of. In mid-July I got on a plane and flew to Kilimanjaro airport in Tanzania with 7 medical students from UC Irvine. UC Irvine's medical school is small and encourages its students, after their first year of training, to do interesting projects in the summer, before returning to immerse themselves in massive absorption of data and passing of standardized tests. I met some of these students while doing my mini-bedside ultrasound fellowship, when I acted as preceptor to a group who staffs a regular rural health clinic in Mexico. A project to teach ultrasound in Tanzania was in the planning and not-quite-sure-if-it-would-happen stage, and I signed on, in a not-quite-sure-I-was-coming kind of way. 5 months later I got off of a plane with medical students, took...

I was interested to read the recent article in the Journal of the American Medical Association entitled The State of US Health 1990-2010, the Burden of Diseases, Injuries and Risk Factors . It is a vast compilation of data from various surveys and data banks using the methods of the Global Burden of Diseases, which has been performed for 50 countries, allowing comparison on a variety of measures. The article is a clear presentation of that data, and I won't repeat that, at least not much. In the last 10 years the US has had a significant improvement in life expectancy, from 75.2 to 78.2 years. This is a good thing. Other countries, though, had more significant improvements, so we dropped in ranking among these countries from 20th to 27th, behind Chile and just ahead of Poland. We also spend much more money on health care than they do. We are the very top country in terms of percentage of gross domestic product spent on health care, at over 16%, and Chile spends about half that....

I just got back from Tanzania, where I supervised 7 medical students who were doing a couple of really awesome ultrasound projects in Mwanza, the second largest city in this East African country. I will write about the projects in a different blog. Mwanza is right on the shores of Lake Victoria, a huge but relatively shallow body of water which Tanzania shares with Kenya and Uganda. Tanzanians are friendly, and the weather in Mwanza was perfect. We were at the tail end of the rainy season, but saw almost no rain, and the temperature was perfect, in the mid 80s during the day and cooling off at night. Because of the lake, there are huge numbers of birds, egrets, cormorants, storks, kingfishers, brightly colored starlings, and lots of frogs who became vocal at night. Tourists do not come to Mwanza, probably because there are more jaw-droppingly amazing places nearby, including Mt. Kilimanjaro, the island of Zanzibar and the Serengeti. People speak English and Swahili, but mostly Swahil...