Doctor Adam Dorin’s column online at The Washington Times:

Under Obamacare, many medical specialties will suffer irreparable harm; the underlying reasons for this signal a poor prognosis for the American health care delivery system as a whole. The public is right to support the noble goals of health care reform, but would be wise to understand the safety implications of the sweeping health system changes underway.

#1:  Mandates and bureaucracy do not equal safety…

Simply saying you want to decrease medical errors and improve safety is not enough to effect positive change in the health care environment.

President Obama correctly identifies a litany of challenges in reforming the
U.S. health system: improving morbidity and mortality statistics for various
diseases, the need to implement information technology systems across the board
(e.g., the electronic medical record), upgrading access to care for all
Americans, affordable prescription drugs, etc.  These are obvious and noble
goals toward any meaningful national health policy reform.  What the President is missing, however, is a high-profile, non-political approach to tackle the most under-reported and troubling reality of theU.S. medical system: safety loopholes that needlessly lead to over 100,000 error-related deaths (and over 1.5 million medical errors) in American medical institutions each year.  Are we to believe that Obamacare will help improve this statistic, or will medical care deteriorate under greater federalist control and authority?

Consider that the current rate of mortality due to drug ‘mistakes’ and other
medical errors has been compared to a large jetliner full with passengers
crashing every couple of days.  The number of deaths from car crashes alone, or
AIDS alone, in any given year is less than the number of iatrogenic (provider-caused) deaths in the United States.

There are many studies and initiatives underway to further elucidate the reasons for the roughly one hundred thousand avoidable deaths attributable to health system
errors per year.  Some conclusions and statistics have already begun to trickle
in, and they place large blame on medication labeling errors, medical management
or judgment errors, and deficiencies in skill (e.g., performing a given
procedure or surgery for which one is not qualified).

Here are some additional facts:

One in five medications in health care
facilities is incorrect (wrong time, wrong dose, or unauthorized drug)–Archives
of Internal Medicine 2002 (Sept 9); 162 (16): pages 1897-1903;

Two percent of
those admitted to a hospital experience major disability or death–Int J Qual
Health Care 2000 (Oct); 12 (5): pages 379-388.

One and a half million people
per year in America require hospitalization and one hundred thousand die as a
result of prescription drug-related injuries–Journal of the American Medical
Association 1998; 279:  pages 1571-1573.

American politicians need to be frank with their constituents with regard to the
realistic ability of any national health system to literally ‘pay for
everything’, but a focused effort to reign in medical errors will more than pay for
itself multiple times over. The President, in advancing the cause of national
health care reform should know better than to play doctor with the crucial
issues of patient safety and medical resource allocation.  There is a problem with medical errors, but could Obamacare make things worse? Will giving more money to the U.S. Postal Service increase the quality and efficiency of its systems? Health care is not mail delivery, but these are important questions to ask.

Underlying the wonky budget analyses and political gamesmanship of the ‘Affordable Care Act’ legislation, there are real medical quality, safety, and security issues which must be afforded the light of day to fully appreciate. Some will praise the recognition of medical errors in the PPACA legislation through further regulations, rules, and oversight, but simply throwing taxpayer money and more bureaucracy at a known problem will not, in and of itself, help solve the problem.

 #2:   Physician, not politicians, should have crafted health care reform…

Although the American Medical Association (AMA) signed on to support Obamacare, the majority ofAmerica’s physicians did not. In fact, about 85% of practicing community doctors in America are not AMA members and do not support the ‘Affordable Care Act’.

Contrary to common lore, most physician are not rich. By increasing the number of low-paying ‘Obamacare card-carrying’ patients they will be asked to see, and failing to address the long-term Medicare (‘SGR’) payment formula for physicians, many quality docs will be forced to restrict, rather than expand, their services (or close shop altogether). The recent Congressional two-month extension to the ‘Doc Fix’ problem is unacceptable.

The medical field demands that the best and the brightest students make a huge personal sacrifice of time and expense. Most medical students finish their residency training at the age of about 30 or older; their undergraduate and graduate school debt ranges from $250 thousand to $600 thousand or more.  Coming ‘out’ to the work force a decade later than most in their age group, and working 80-100 hour work weeks is stressful business for doctors.  Medicine is a fascinating and wonderful profession, but the undertaking demands the highest caliber individual. There are two ways to insure that American doctors remain the best in the world: sustain competitive, free-market incentives, or go completely ‘socialist’ by paying for the entire process of medical education and training as is done in many European countries. Obamacare does neither, and thus leaves physicians dangling in a precarious position as education costs continue to climb and reimbursements continue to fall.

Every President, every congressman, and every person who has every worked in or around the White House, the Pentagon, Capitol Hill, or any other elevated branch of government  receives the very best the American medical system has to offer. This basic assumption of quality, and the implicit policy of safety under a physician’s care, will always be there for those with power or means; under Obamacare, the powerful will continue to be well cared for. But for the rest of America, this assumption will likely not hold.

In 1993, the Centers for Medicare and Medicaid Services, then known commonly as ‘Medicare’, cut the reimbursement for my specialty of anesthesiology by roughly 70%.

Many other specialties have received large cuts in reimbursement since. Anesthesiology as a specialty was able to survive in teaching institutions, community hospitals and surgical centers because of higher reimbursements received by private health insurers.

Under Obamacare, there will be an expansion of what are called ‘physician extenders’. Many patients may not consider the care of non-physicians to be an acceptable replacement to their doctor. As more and more companies drop their private health insurance plans, and society moves toward a nationalized, single-payer health care system, doctors will no longer be able to afford to meet expenses, pay off educational loans, and be incentivized to endure the challenging and demanding years of study and training to become board-certified.

Only in America can a pregnant patient expect an obstetrician to be accompanied by a board-certified anesthesiologist at any time of the day or night to place a labor epidural to ease the pain of childbirth. Only in America can a patient expect the highest degree of anesthesia experience, surgical expertise, radiological skill, and internal medicine know-how to guide them through treatments for advanced and complex disease. Only in America, today. With every year we move forward under the new health care legislation, these services, which we take for granted, will recede progressively. Once gone, finding ample numbers of trained physicians willing and able to provide this highest level of care will be increasingly difficult.

#3:  Misplaced priorities…

All of this brings us back to our esteemed political representatives in America, who will continue to receive the best medical care in the world, while many Americans will have to settle for something less than the best—something far less than what we have now.

Obamacare was crafted in back rooms to satisfy political goals and schemes, but not to expand the delivery ofAmerica’s best medical care to all Americans.  In the absence of major changes to the Obamacare legislation, danger in terms of physician coverage for hospitals and physician availability for office visits lies ahead.

None of us would fly on an airplane without a trained and experienced pilot in the cockpit. Then why would we allow ourselves to ‘go under’ without an anesthesiologist at the head of our bed in the operating room, a cardiologist treating our heart problems, or an internal medicine specialist physician writing our prescriptions?

TheUnited States health system is not perfect and our heterogeneous population poses tough challenges, but our philosophy has always been to go the extra mile to treat our patients. {For example, theU.S. has perhaps the most advanced premature infant treatment programs in the world. Here, we do everything we can to save lives, even for the weakest, prematurely delivered babies. Obviously, in doing so, we extend great cost and also accept a greater mortality rate for this vulnerable population. If you espouse the Michael Moore approach to statistics, you’d say that Cuba had superior infant mortality rates to the U.S.; of course, you’d be dead wrong. In fact, Cuba has the world’s highest abortion rate, and thus discards the lives of babies who are never given a chance to become infants–and thus never entered into the equation used to calculate ‘infant mortality’.

For those who believe Mr. Moore is correct about superior medical care in Cuba, that nation’s services are only a boat ride away. For the rest of us who value the worth of American medical institutions, I suggest we look past mere constitutional challenges to Obamacare, and focus our attention on the fundamental flaws in safety in its design.

Be wary of the enemy at the gate. Health care reform is tricky business and the ‘Affordable Care Act’ does not have its act together. The Obamacare journey to the future could be a very treacherous one indeed.

Issues of medical safety, security, and health care reform are covered in more depth at America’s Medical Society (

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