Correspondence
The Presidential Candidates and Health Care
N Engl J Med 2001; 344:1480-1481May 10, 2001
- Article
To the Editor:
In the presidential candidates' discussion of their vision of health care (Oct. 19 issue),1 George W. Bush refers to the concealment of medical errors due to the perceived risk of litigation and calls for research on why errors occur and how they can be prevented, making the statement, “That is why a cloak of secrecy envelops operating rooms.” I am unsure why President Bush believes adverse events in operating rooms are more likely to be concealed than those in any other arena of medicine. In fact, anesthesiologists have led the way in attempting to detect, document, and prevent critical incidents in the operating room long before the issue became political. The American Society of Anesthesiologists's Closed Claims Project and Anesthesia Patient Safety Foundation are just two vehicles for promoting safety and the discussion of mishaps in the operating room.
This open acknowledgment that mistakes are made and can be learned from has without doubt created standards of vigilance that have reduced morbidity and mortality in the operating room substantially over the past several decades. It is unfortunate that many people still believe, as President Bush does, that a code of silence pervades medicine. It is up to physicians to prove this belief wrong by admitting their mistakes and learning from them.
1 ReferencesJason W. Ryan, M.D.
Brigham and Women's Hospital, Boston, MA 021151
Drazen JM ,Bush GW ,Gore A . The Republican and Democratic candidates speak on health care. N Engl J Med 2000;343:1184-1189
Full Text | Web of Science | Medline
To the Editor:
I was delighted to see the presidential candidates discuss their plans to improve health care in the United States. However, I was very disappointed with the similarity of their proposals. Both candidates planned to tinker with the current health care system, which currently leaves over 40 million Americans uninsured. Even those fortunate enough to have insurance are often placed in an adversarial relationship with their physicians and are relegated to struggling alone against the giant bureaucracies of profit-driven health maintenance organizations. A more meaningful discussion would have included Ralph Nader's platform on health care, which proposed a single-payer system covering all Americans, regardless of their financial status or age.
According to the World Health Organization, the United States ranks 37th in the world in the quality of health care delivered to its people. We are the only industrialized country in the world that does not offer national health insurance, and our comparatively low health indicators and astronomical health expenditures reflect our failure to address this critical public health issue. Sterile debates about piecemeal approaches to increasing health care coverage are distracting and do not allow us to consider our options fully. It is a sad commentary on our democracy that Nader, the one presidential candidate who offered a meaningful solution to the problem of how to improve health care delivery, was excluded from the debate.
Reuben Granich, M.D., M.P.H.
2151 Berkeley Way, Berkeley, CA 94704Author/Editor Response
The editor replies:
We made an editorial decision to limit our debate to the candidates most likely to garner a substantial fraction of the popular and electoral votes. As always, we are willing to consider for publication thoughtful pieces from responsible parties on all sides of an issue.
Jeffrey M. Drazen, M.D.
