Why is American health care so expensive?

I've been thinking about police violence, crime, the criminal justice system and its horrors, racial barriers to success, fear and racism in general. It's been a busy few days as I've tried to educate myself on problems that have been impacting black and brown people for a long time. The video clips that are now circulating are bringing the reality of police violence and disrespect to even people like me, who are protected from that reality by accidents of birth and the privilege of living in a peaceful place.  I've been able to generalize those visuals a bit. I have also listened to the stories of my formerly incarcerated patients. The experience of people in poverty, especially when non-white or vulnerable due to homelessness or mental illness, is that police are to be feared. We are now seeing people die because of interacting with police, but that isn't even the biggest problem. There are far more people who are injured physically, mentally or through inappropri...

I have recently become aware that some people are mistakenly getting suspicious that Covid 19 death counts are an overestimate. That is probably because the numbers are awful and very hard to visualize. Nearly 110,000 deaths have been documented so far in the US, which is undoubtedly significantly below the actual number who have died from the disease (see my previous blog on the subject, from very early on in the pandemic.) Our freshman US representative in Idaho, who serves a dark red district of a very conservative state, recently wrote a letter to the CDC concerned that the guidance they have given regarding filling in death certificates will lead to a falsely elevated number of people who have died of the disease. I just wrote Mr. Fulcher a letter explaining why this is wrong. "I saw your letter in your recent email encouraging the CDC to count Covid deaths accurately. I think you may not know some of the nitty gritty of documenting cause of death from a doctor's standpoi...

I am not especially qualified to write on the subject of racism or the militarization of policing or how the criminal justice system perpetuates poverty and loss of opportunity based on race. I am white, grew up in predominantly white neighborhoods and have always had certain expectations based on those privileges. Like most people I have my own story flavored by my own challenges. None of these challenges are based on race. I have watched from my safe community where police generally act like good people. (Obviously this is from my standpoint which may not represent everyone's experience.) As a doctor I have cared for police refugees from big cities, retired officers whose experiences of police culture drove them away and marked their personalities. I have enough connection with people on the receiving end of the criminal justice system in other communities that I am not entirely ignorant, but my experience is definitely limited. So in this time of Covid 19 and now widespread...