Why is American health care so expensive?

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 ...