Why is American health care so expensive?

I just read an article  that documents the far reaching positive economic impact of giving people money. It's well written and looks at context and details so perhaps you should just read it instead of taking my opinion. OK. You did? Great. Now here's my take: A nonprofit, GiveDirectly , has been experimenting with simply transferring a single sum of money to families in extreme poverty in certain villages in countries in Sub-Saharan Africa. The amounts of money are very large compared to the families' usual income, in the recent study around $1000 USD. The recent study looked at a village on the banks of Lake Victoria in Kenya and the recipients were everyone in the village whose house had a thatched roof (an indication of poverty since richer families have metal roofs). The results were less hunger, more investment in farming and small business, more ownership of livestock and increase in overall happiness. The effects also extended to people in the village who did no...

The Problem (which sounds pretty bad) Climate change. Global warming. The greenhouse effect. Devastating wildfires, dangerous air quality. Catastrophic weather events and mass human migration. It all sounds like post-apocalyptic fiction except that it's real. Inside our air-conditioned offices and homes it can still be possible to be optimistic. Maybe it's nothing out of the ordinary. Maybe it isn't our fault and would have happened without human activity. Maybe we don't know what will happen and it won't be that bad. If we jettison optimism and embrace responsibility it is easy to become overwhelmed and paralyzed. And possibly a time will come when the best approach will be to just hold our spouses, children, grandchildren and animal companions close and tell them we have always loved them. But now is not that time. So many humans! In a recent issue of the New England Journal of Medicine, Deborah J. Anderson wrote an article entitled Population and the E...

I gave my 3 month notice about 4 months ago now. It was clear that the rural hospitalist program in which I worked was not going to continue to be my happy place. (Corporate medicine, hospital acquiring outpatient practices, staff changes, politics, health care trends leading to everything progressively sucking, see prior blog post ...) What next? First, I could do exactly what I was doing a few years ago (filling in at hospitals in need all over the region), without working at my local hospital. I could go to the hospitals I knew well in neighboring states and do hospitalist shifts as a locum tenens physician. I could even sign up for regular part time work, say 7 days a month of either 12 or 24 hour shifts, somewhere within a day's drive of where I live. The money would be good and the time off pretty well uninterrupted with adequate blocks of time to travel and teach ultrasound. Sounds great, except for that week. Seven days of high stress, being away from home, the likeliho...

In 1980 I worked as a nurse's aid for a summer. It was a great job, in its way. I had no training and I worked nights in a nursing home. This meant that I rounded pretty much all night long, helping when people woke up and needed something and changing the sheets of the many incontinent residents. I would feel for wetness, then gently roll up the soiled sheets on one side of the patient, replacing them with clean ones, roll the patient over the lump, wrap up the dirty ones and tuck in the clean ones. (This was before high quality disposable diapers were introduced.) I would walk the lost insomniacs back to their rooms and reassure anxious people. I was paid next to nothing, I'm thinking maybe $6 per hour, but that's what I expected and it paid the rent. For me it was just a stop on the way to a job as a doctor. Just last week I was at a singing camp with a bunch of people of various ages and backgrounds and got to know a woman who is an EMT ( emergency medical technician ...

I delight in learning my patients' stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary mystery to be solved, my Sherlock Holmes moment. This is why, if somebody asks me, I will tell them that doctoring is the best job in the world. The opportunity to connect fully with another human being and use my heart and hands and brain to help them is a profound gift and a sacred trust. When I'm not so overwhelmed that I can't function, that is. Lately at work, with the recent flu epidemic and the collateral illness that a hard winter has brought on, my job as a hospitalist at my local rural hospital has become rushed and nearly overwhelming. I cut corners in ways that I hope will not compromise patient care. At times I dream of retiring, forgetting that I'm a doctor, letting the skills I've been collecting over these 30 years drift away like objects at a garage ...

The New York Times is interested in fecal transplant. This is the euphemistic term for taking feces, poop, crap, sh*t, bowel contents from one person and putting it into another person. There are various procedures for doing this, from drying it and putting it into capsules to making it liquid and introducing it by enema, nasogastric tube or colonoscopy. It is a remarkably effective treatment for a wide range of illnesses which appear to be related to an unhealthy gut biome (bacterial community.) Politics: The New York Times has published several articles about it in the last few years including a recent one in which they introduce the politics of fecal transplant (also "fecal microbiota transplantation" or FMT). Apparently several companies have been working on ways to monetize human excrement for medical use. At the same time, doctors have been using do it yourself concoctions and a non-profit in Cambridge Massachusetts has been packaging a fully screened selected-don...

Antibiotics are a miracle, killing the bacteria that might otherwise kill us. They are also dangerous, with side effects that can be fatal as well as merely annoying. They kill good bacteria as well as bad ones, disturbing the delicate balance of the bacterial communities with which we share our bodies. Intravenous antibiotics can work quickly to forestall life threatening blood stream infections and can reach high levels in the blood and penetrate structures such as bone, eventually eradicating infections that might hide out and cause chronic infection. Oral antibiotics, however, are also very powerful and are sometimes absorbed so well that they are just as effective as intravenous (IV) ones. Whether to use oral or IV antibiotics is based on several considerations, but we usually believe that infections on the heart valves or in the bone or joint or artificial joints require IV antibiotics. Long term treatment with IV antibiotics can be logistically difficult. Consider these two ...