Health In America

Stanford Social Innovation Review:

We spend far more on health care than any other nation—a breathtaking $2.6 trillion annually... The US Department of Health and Human Services estimates that health care expenditures will be 25 percent of US GDP by 2025, twice what many developed countries currently expend.
The burden of rising health care costs falls not just on individuals—half of all personal bankruptcies are at least partly due to medical expenses—but also on US companies. At General Motors, health care costs put the company at a $5 billion disadvantage against Toyota...
Despite such spending, US health indicators are among the worst of high-income countries. Since 1960, the United States dropped from 12th to 46th in infant mortality rankings (below Cuba and Slovenia), and from 16th to 36th in life expectancy (below Cyprus and Chile), according to the CIA’s World Factbook. In certain neighborhoods in Baltimore, Chicago, and Los Angeles—and other communities across the country—life expectancy for subsets of the population is lower than in Bangladesh.
...Primary care doctors are the key to improving value-based care: By focusing on preventive services, care coordination, and disease management, they can reduce unnecessary health care costs. In the 1960s, half of the doctors in the United States worked in primary care. Today, barely 30 percent do. And this trend is deepening: From 2000 to 2005, the percentage of US medical school graduates who chose to enter primary care dropped from 14 percent to 8 percent.

Overtreated Vaginas and Tonsils

Most pelvic exams are unnecessary, but they are frequently required by doctors before they will give a prescription for one of the most commonly prescribed medicines: birth control pills.  There are more birth control pill prescriptions each year than antibiotics.  

The US Preventative Services Task Force, an independent group of national experts that makes evidence-based health care recommendations, released new guidelines declaring definitively that women over 30 don't need a Pap smear more than once every three years unless they have a couple of risk factors, which I don't have. The American Congress of Obstetricians and Gynecologists has said that birth control pills can safely be prescribed without a full-on exam. Doctors, though, don't seem to be in any hurry to give up old habits. ...I emailed my doctor, citing the new guidelines, and asked if he could give me a new one-year prescription for birth control pills without a pelvic exam.

He wrote back, "Yes, one can argue about whether or not you need a pap, but ...I would still like you to come in. See you soon?"
The doctor had me over a barrel. As it turns out, my experience isn't unique. Doctors regularly hold women’s birth control prescriptions hostage like this, forcing them to come in for exams that research is increasingly showing are too frequent and often unnecessary and ineffective. A 2010 study published in the journal Obstetrics & Gynecology found that 33 percent of doctors always require a pelvic exam and Pap smear for a hormonal contraception prescription, and 44 percent regularly do so, even though there's no medical reason for linking the two.
Indeed, there's a growing body of evidence that the entire annual ob-gyn exam, with the mandatory and miserable pelvic exam where doctors poke around one's uterus and ovaries with their fingers, is largely obsolete. For instance, there's no evidence that doctors can diagnose ovarian cancer with a pelvic exam in women showing no symptoms. A clinical trial found that doctors were unable to identify any cancers in test subjects by pelvic exams alone, and the National Cancer Institute no longer recommends the tests for postmenopausal women. ...The scientific basis for much of the traditional well-woman ob-gyn annual check-up is so slim that "the routine pelvic examination may be an example of more service leading to worse outcomes," Dr. Carolyn Westhoff, an ob-gyn at Columbia University, wrote in the Journal of Women's Health last year.

Virginia Postrel suggests that the controversy between the Catholic Church and the US government could be mostly solved by eliminating the prescription for oral contraceptives.  Making them available over the counter would eliminate the controversy as it applies to oral contraceptives, and it would make them much cheaper.

Right now, the American women who have the most choice are those who live near the border with Mexico, where pharmacies sell oral contraceptives without a prescription, generally for about $5 for a one-month supply. A group of researchers [] conducted extensive interviews with more than 1,000 women who live in El Paso, Texas....One result from the El Paso study surprised researchers. “Women who got the pill in clinics were significantly more likely to stop using it during the study — even though they still didn’t want to get pregnant,” Grossman says. That’s a big deal. In fact, he says, “my hope was that we would show that continuation was no worse for the OTC group, but in fact we showed it was better.”

Oral contraceptives are already available over the counter in most countries of the world, so this can work fine.  Kevin Drum notes that this kind of easier oral contraceptive access produces a big reduction in pregnancy and abortion rates.  This is the difference between women in California who needed monthly prescriptions and women who got a year supply. 

There is a tonsillectomy fad underway in medicine which raises costs and increases risk of iatrogenic illness for most patients rather than healing them:

It turns out we’re in the middle of ...a tonsillectomy epidemic,... Tonsillectomies are the most common procedure, for children, requiring anesthesia. ...The number of tonsillectomies performed spiked by 74 percent between 1996 and 2006. In 2006 alone, more than a half-million children in the United States got their tonsils removed. The only problem is there’s no evidence they work for most children.
The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder.
....“It’s a silent epidemic of unnecessary care,” says the Dartmouth Atlas’s David Goodman, .... “In most instances, it’s done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers.”
...Unnecessary health care is estimated to cost at least $158 billion every year.
...Most doctors are paid for the volume of services they provide, creating an incentive to provide more care even if it might not be indicated. That does not quite explain the surge in tonsillectomies: As a relatively simple procedure, it’s not one that will bring in significant revenue, in the way that more complex treatments, such as those for cancer and end-of-life issues, would. “There’s not a lot of money in tonsillectomies compared to end of life care,” says Goodman. “Providers are by and large well-meaning here.”
Goodman and others have focused a lot on the medical education system as one key culprit. Medical school often focuses on teaching how best to treat patients, with little time spent discussing when treatment doesn’t make sense.