Why is American health care so expensive?

I just got back from the Haitian island of La Gonave (lagonav in Creole) after 8 days there visiting people who work on projects we help to fund. I'm glad to be home, because this is where I live and I missed toast with jam, my dog, and not being sticky sweaty all the time. Still, it was a wonderful trip and full of things to get excited about. I first visited Haiti in 2010, about 3 months after the big earthquake hit the main island and killed 250,000 plus people, primarily in Port Au Prince. I went to La Gonave, 35 miles off the coast of Haiti, on a trip that was planned before the earthquake and which had nothing to do with the acute worsening of misery associated with the widespread destruction of the main island's marginal infrastructure. La Gonave was definitely affected by the earthquake, but nobody was killed, mainly due to the fact that there were very few large buildings and very few people inside in the late afternoon in the few places that did collapse. Poorly c...

I frequently throw away the American Journal of Medicine (the "Green Journal") without reading it because it is not one that I actually ask for and it doesn't address questions that I find interesting. Lately, though, the quality of the material is better and I am more likely to pick it up and page through the articles. Today I found that there were two editorials on the use of handheld ultrasounds, specifically the Vscan, the little pocket model that I have used for the last nearly 2 years as a diagnostic tool at the bedside. One article , by Julie Kim MD and colleagues from Northwestern University in Chicago, IL presented the opinion that these devices should only be used as part of clinical trials or for evidence based indications. They based this view on a review of the literature which showed few prospective trials showing improved patient outcomes. The following article , by Roy Ziegelstein, MD and David B. Hellmann, MD points out that "wise use of hand-c...

I just read an article in the Journal of Patient Safety by a NASA toxicologist and patient safety advocate, John T. James PhD, which addressed the question of medical errors in hospital settings. Dr. James evaluated the results of 4 studies of patient adverse events (PAE's) and extrapolated the results to estimate that 400,000 deaths yearly are associated with preventable patient harms. The Harvard Medical Practice study which reviewed records from several New York hospitals in 1984 estimated that deaths due to medical error numbered about 98,000 per year, and that number has been quoted widely and embraced as the truth by the Institute of Medicine, a nonprofit organization which seeks to advise patients and decision makers about important issues in medicine. This current article uses different methods and suggests that the number may be much higher. After reading the article about the article on a public interest site on the internet, I perused the comments, which were primar...

A 100 year old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. She takes no medications and hasn't been to the doctor for a decade. She has no living family and her friends have their own lives and problems. She can't go home because she has just gotten too old. What shall we do with her? When the law establishing Medicare was enacted in 1966 as title XIII of the Social Security Act during the presidency of Lyndon Johnson only half of seniors had health insurance and many had no access to healthcare because they couldn't afford it. Now nearly all seniors in the US have insurance coverage for both ambulatory and hospital care. M...

I admit it. I am an ultrasound nerd. Zealot would be another word. I am someone whose enthusiasm for bedside ultrasound is strong enough to overwhelm my desire not to bore other people. Still, it has taken me to very interesting places and put me in contact with good, devoted people whose passion to make medical care and teaching better and more accessible mirrors my own values...even the values I had when I thought that ultrasound was something that technicians did in little dark rooms which produced un-readable blur-o-grams. After learning the basics of bedside ultrasound in an introductory course 2 years ago and working on becoming proficient through hours of practice and other formal training I got to go with medical students from UC Irvine to Tanzania  to teach basic ultrasound and practical anatomy to students in Clinical Officer training school and other physicians. They have kept in touch and presented their work in a meeting in Columbia, South Carolina, the Second Annu...