A reader writes:

Your reader's response to Megan got a lot closer to the core of the problem with healthcare costs. I am a physician in an emergency room in New York City, and every day I see tons of cash needlessly flying out the door due to "the Burger King factor." American patients often come to the ER with very minor complaints - back pain for which they have not even tried tylenol, nasal congestion for two days, itchy mosquito bites, and so forth. All of them expect something from you, quickly, for their trouble - and it must meet their preconceptions or they will accuse you of ripping them off.

Many of them become virtually incandescent with anger if they aren't given some kind of medical test that they (or one of their friends) thinks is a good idea, but they don't really need. They insult you, they threaten you, they loudly announce that they're going to call their lawyer or the hospital administrator, etc. Sometimes we stand up to them, and sometimes we're too exhausted to fight. Sometimes it's just easier to get the x-ray on the patient with back pain rather than take the abuse and argue with them for 40 minutes and then have them send an angry letter to the review board. Others are simply beyond the pale and can't put anyone else ahead of themselves. Some are incensed that I have to see a critically ill patient before I see them, because "I got here first." People will literally interrupt cpr to scream that they want a sandwich or something to eat NOW. People want a blood test, a cat scan, an EKG, anything in exchange for their time. People will quote TV shows as medical authorities. All of us have our favorite 'placebo' methods to try and gratify these patients, from ultrasounding their skulls (safe, dramatic, shows nothing but costs nothing) to pointing an ultraviolet flashlight into their maalox before they drink it. It's our version of wearing a wooden mask and shaking a rattle - we hate it, and patients love it.

The amazing thing is that when needless tests come back negative, the patient is completely satisfied. There is never a sense of regret, or how much money they just wasted, but rather one of accomplishment, even if they still have the same problem they walked in with.

Ultimately, the American sense of entitlement, so long appeased and encouraged by our commercial culture, is what is poisoning the healthcare system. Doctors have played into it and are just as guilty for caving in when they know better, or billing for procedures a patient doesn't really need. We have played along and made medical glitz into the standard of care, feeding and feeding off of a narcissism that cannot be satisfied. It is a uniquely American problem, which is why the solutions that other nations have reached will not work as well for us.