John on August 20, 2009 at 12:29 pm
Today’s Wall Street Journal has a op-ed by anesthesiologist Ronald Dworkin:
Every medical student learns an old adage: You can skimp on some medicine, but you can’t skimp on obstetrics or anesthesiology. An elderly surgeon explained it to me this way, “In surgery, people die in days and weeksâ€”a doctor has time to fix a mistake. But in obstetrics and anesthesiology, they die in minutes and seconds.”
Incredibly, Congress’s proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.
In no medical specialty is the spread between the Medicare rates and private insurance rates greater. Progressives expect to pay anesthesiologists Medicare rates, which are 65% less than private insurance rates, without any change in the system. But there will be changes. Some anesthesiologists will leave the field. They are already faced with lawsuits at every turn. Something else has happened in America that threatens to tip the balance for anesthesiologists. Americans have grown very fat. This complicates anesthesia tremendously. Putting in IVs, spinals and epidurals is harder. Inserting breathing tubes is much more dangerous.
Quality of care will inevitably decline. That decline will come first in obstetrics. At the hospital where I work, two anesthesiologists work in obstetrics almost around the clock, so that a woman in labor need not wait more than five minutes for her epidural. Other hospitals are less fortunate, and have on staff at most one anesthesiologist in obstetrics. The economic crunch will eventually force these hospitals to cover obstetrics “when anesthesiology is available,” meaning in between regular operating room cases.
During an obstetrical emergency, these short-staffed anesthesia departments will scramble to send someone to perform the C-section. Don’t forget, a baby has only nine minutes of oxygen when the umbilical cord prolapses, so time is of the essence.
At the very least, pregnant women will be waiting a lot longer for epidurals. But more pain on the labor floor is only the beginning. If hospitals delay the administration of anesthesia because Congress skimped, needless deaths will certainly result.
This is one of the many unintended consequences of reform that many will only discover when it’s too late to do anything about it. Even then, the chain of causation will be complex enough that only those working in the field will make the connection between distant government intervention and immediate unrelieved pain. Nevertheless, it’s a real connection.
Category: Health & Education |