Andrew Stephen saves $9,000

The dentist said I needed an extraction and implants that would cost $9,000. Knowing how things work

I first noticed the syndrome when I arrived to live in DC nearly 17 years ago and took our ageing British cat, Paws, to the vet for her mandatory shots. He insisted on giving her a medical, too, and then chastised me sternly: "There is a huge build-up of tartar on her teeth. You must brush her teeth carefully at least once a day." I left shamefaced, promising to do better.

It was a long time before I realised this was complete lunacy and that it extended to human medical and dental care, too. Last week my dentist insisted that I had to have a tooth out and needed dental implants that would cost $9,000. Having wised up to the way things work here, I asked him to call in a colleague for a second opinion. The result? No tooth extraction, no implants.

Meanwhile there were dramas with our dog. He had developed a sore on his leg that he kept biting and making worse - which, as any dog or cat owner knows, is invariably cured by putting a cone around the animal's neck to stop it getting at the sore. I should have known better, but took him to a vet. I left $394 poorer, with the vet not only having prescribed high-tech antibiotics that cost more than $150, but also insisting on taking a urine specimen for lab tests. And, he threw in casually, our dog must have his prostate removed - not for any good reason, as far as I could make out, but to guard against future problems that might or might not arise.

Next day the vet phoned me to say the lab tests were negative and that we could stop the antibiotics. I told him the dog's sore was getting worse and he said he would phone through a prescription for ointment to my local drugstore. This time the bill was a mere $47, but walking back I had a blinding realisation: the reason for the worsening of the problem was the exceedingly low-tech one that the vet had put on a collar that was too small, thus enabling poor Buster to continue to gnaw away at his sore.

Experiences such as these (and I could go on) have convinced me that Americans - with the exception of the 45.5 million who have no medical insurance, naturally - have gone completely bonkers when it comes to their divine belief in the efficacy of high-tech medicine and the omnipotence of its practitioners. "We have the best medical care in the world" is a mantra you never stop hearing here.

Let us look at the facts. Americans spend $1.9 trillion a year on medical care, which amounts roughly to a sixth of the US economy. Yet it is overwhelmingly clear that they do not get value for money: if you take infant mortality and life expectancy as the basic indicators of a nation's health, many countries that spend vastly less on healthcare are in better shape. Britain, with its much-maligned NHS (ie, its dreaded "socialised medicine"), has lower infant mortality rates, and its men and women live longer than Americans (not that there is any room for complacency: the figures are quite close). The French and Japanese, though - to take just two other random examples - are markedly more healthy than Americans.

Which brings me to the pharmaceutical companies. Well over half the population are taking at least one prescription drug, at least partly because they are bombarded with television ads for them. The tennis player Serena Williams, for example, is always prattling on about a cure for menstrual migraines. More omnipresent still are the attractive, fortysomething wives (ie, actresses) smiling satisfied, coy smiles because their husbands (ie, actors) have taken Viagra or the like.

Even the most conscientious doctors, as a result, find themselves wearily writing prescriptions for expensive drugs they know their patients do not need. The pharmaceutical companies have one salesperson for every doctor in the US; they also have more lobbyists in DC than the entire membership of the House and Senate combined.

The predictable result is that politicians are snugly in bed with the drug giants. When I came here I found that generic warfarin, which has existed for more than half a century and costs little more than aspirin if bought privately in Britain, was simply unavailable because the Food and Drug Administration would not approve its use. As a result DuPont's proprietary brand had a stranglehold on the market at more than $100 for 40 tablets. (Generic warfarin has since been approved for use, doubtless prompting outrage at DuPont and the sacking of innumerable lobbyists, but is still wickedly expensive.)

That's my report this week, then. Buster Stephen is getting better because we finally tracked down a pet shop that sells the cones we thought were available only from vets. That inveterate traveller Paws Stephen lies peacefully in a Georgetown back garden after a tearful funeral (Book of Common Prayer, 1662 version). And I will keep my tooth and avoid dental implants - quite possibly, the second dentist said, to the end of my days. I have finally wised up to the system, you see, unlike the vast majority of Americans.