Malpractice insurance, and the associated extra costs of "defensive
medicine", are indeed part of the US healthcare economic situation.  
They are, by no means, the only parts.

We know several ways to decrease the incidence of malpractice, but
there's resistance -- although this is changing with a newer generation
of physicians. Every study of malpractice suits shows that the #1
preventive is having physicians TALK to their patients, give the
impression of at least giving time if not actually caring, and, if
there's a problem, admit it quickly (which the lawyers say is the last
thing to do).

There are also great opportunities for risk reduction (aside from
efficiencies) by greater automation in clinical practice. A very large
part of medical errors are due to incorrect (or unreadable) prescribing,
of drugs or treatment. The Institute of Medicine of the National Academy
of Sciences recommended that the prescription pad be used only in
extremely unusual cases -- prescriptions should be written with a
computer-assisted prescribing system. The more access that system has to
the patient's medical record, the more problems it can avoid, the better
the mixtures of drugs it can recommend, and it can come up with cheaper
regimens that have better compliance.

One of the biggest problems, however, is what would be called a shell
game in any other industry: "cost-shifting".  This is caused by a
combination of the US historical artifact, the employer-based system,
and unfunded mandates.  When I speak of reforms, I am NOT speaking of
"socialized medicine", but actually letting the free market work. The
problem is that free markets depend on interaction between consumer and
provider. The US system alters that to an interaction between employer,
for which healthcare is overhead, and benefits managers (sometimes but
not always insurers) who manage reimbursement. While there were distinct
problems with the entire Clinton health plan, one part, which both Bush
and Kerry recommended to differing extents, is to get the employer out
of the loop and have consumer cooperatives contract with
providers/benefit managers. Both Presidential candidates suggested that
certain small businesses, etc., be allowed to buy into the single very
large system in the US that uses this model very successfully: the
Federal Employees' Health Plans.

Right now, the reimbursement received, for the same procedure, by a
provider differs with the market leverage of the third-party payor. Big
insurers, Medicare, etc., can get away with paying artificially low
rates, which sometimes don't cover costs.  The providers, still having
costs to cover, increase the bills to less well insured and self-insured
patients.

Adding to the problem is the major unfunded mandate called EMTALA, which
requires patients to be seen and stabilized in emergency rooms without
regard to ability to pay.  Socially, I believe this is a good thing,
but, as a Federal mandate, I believe the uncovered costs should be
reimbursed from Federal taxes -- not cost-shifted.  I can look at one of
the top hospitals in Washington DC, which receives critical shooting
patients from the drug wars. Such people are rarely insured. It's very
easy to run up costs of hundreds of thousands to stabilize a multiple
gunshot patient.  Sometimes, the hospitals can get these patients on
Medicaid, but, all too often, the costs get shifted onto the insured and
self-pay patients.

As an example of how radical the discounts can be, when I received my
pacemaker, the "list price" for the pacemaker itself and the
implantation was $24,000.  Combining reimbursement and my copay, it cost
me $1800. My benefits were managed by the #2 manager in the industry,
with great market power.

If it's any consolation, testosterone (well, to be precise,
dehydrotestosterone) causes male pattern baldness. I may discuss some
androgen supplements with my endocrinologist, to see if it would be
useful in weight loss. There's a gel preparation that seems to be lower
in side effects than the other forms of anabolic steroids, which I
flatly would not take.

One of my key blood pressure drugs is oral minoxidil, which, taken
orally -- and it is a potent drug with side effects to watch closely --
is far more effective in growing hair than Rogaine. I now have grown
back to an area that I can sometimes get away with explaining as "That's
not a bald spot. That's a solar energy panel for a luuuuve machine."

I wasn't arguing, just complimenting her. My husband's sister had the
surgery
and gained most of the weight back over a seven-year period.