Mark Twain famously said that “there are three kinds of lies: lies, damned lies, and statistics.” But he was wrong about the latter, which is understandable given that he could have never envisioned the damning figures associated with American Healthcare.

• The United States currently spends 4.1 trillion dollars per year on healthcare, or about 20% of our Gross Domestic Product. Put another way, we spend $12,000 per American on medical care, which is double what any of the other developed countries spends per year.
• Twenty-five percent of this investment is wasted on unnecessary care—the CT scan that wasn’t ordered without a clear diagnostic purpose, the procedure that shouldn’t have been done, the clinic visit “required” to refill a prescription, all measures that don’t move the meter in terms of health, all measures that have more do with money than health. That’s around a trillion dollars spent per year that doesn’t improve our health one iota.

So, we have invested the money, year after year. But what is the return on that investment? Brace yourself. We are at the bottom among the wealthiest nations in terms of quality by many different measures, including:

• We are last in life expectancy,
• And, have the worst childhood mortality rates,
• And, the highest incidence of maternal deaths.

In other words, we don’t do well at any phase of the life cycle: when we are young and when women give birth to babies. We don’t live as long into old age.

To put the issue into even starker relief, let’s more closely examine life expectancy—a broad measure that speaks to the general health of a country.

• It rose in America over the last century from about 46 years to around 75 years.
• About a decade ago, life expectancy in this country stopped rising. And that was before the pandemic hit.

Okay, so let’s stipulate that American Healthcare has a poor ROI. Let’s agree on that. But what is the root of the problem and isn’t there just some policy fix? Obamacare, universal health coverage, or as some on the Right argue, shouldn’t we just unleash the “private sector?” Won’t one of these solve the problem?

No. There is no government fix—and Medicine won’t fix itself. There are too many incentives to leave it as is. We won’t improve our healthcare, and as a result, our health, until the humanity of medicine is reinserted, its soul restored. Because soulless healthcare is ineffective healthcare.

I started writing this story almost 40 years ago, in my mind at least, because of experiences described in the posts that follow, when I slowly began to realize that the profession I had chosen was not as pure, not as altruistic, not as patient-centered as I had once thought.

You and I have heard stories like these, but there is nothing like seeing it for yourself, during nights in the emergency room, nights just like this…

Go back with me to 1988 when I was a medical student.