A Perfect Tsunami: U.S. Health care reform and a conservative doc in American Samoa

On 9/29/09, an 8.3 earthquake and massive tsunami devastated much of the U.S. territory of American Samoa.  Its fragile health care infrastructure crumbled in the wake of the natural disasters, leaving the 77-square-mile island's residents and visitors with skeleton services.

The only hospital in the region, the LBJ Tropical Medical Center, was overwhelmed with injured patients who had to be evacuated twice in the ensuing days.

I came to American Samoa last week in response to FEMA's call and the LBJ hospital CEO's request.  As a general and trauma surgeon, I believed I could serve the population during a difficult time.

I owe American Samoa.

This tiny U.S. territory's residents enlist in the U.S. Armed Forces at a per capita rate higher than any state in the union.  Their patriotism and commitment to defending our country is widely known in the U.S. military but largely unheard of elsewhere.

And so I came to pay a debt of gratitude in the aftermath of a disaster that leveled villages and filled the only morgue on the island far beyond its capacity.  One of FEMA's first shipments was a set of temporary cold storage units for "overflow" bodies.

Between handling emergency cases (Dengue Fever!), seeing patients in the Intensive Care Unit and helping the reopened surgical clinic catch up, I have followed the progress of Congress as it prepares to debate the most radical remaking of the U.S. health care system since its inception.

On partisan lines with the addition of Senator Olympia Snowe (R-ME), the Senate subcommittee headed by Senator Max Baucus passed its version of the bill.  It is headed now to the Senate floor for debate, probably during the week of October 26th.

I do not quarrel with those who suggest that our system of funding and delivering care could be better.  Improving affordability and access while preserving patient choice and increasing safety are terrific goals that merit serious consideration and good policymaking.

The Baucus health care bill meets none of these goals.

Instead, it drives up the cost of coverage for average families and small business owners. 

Not a single doctor or nurse is added to address the shortage experienced in underserved communities across the country. 

Patient autonomy is threatened, with the bill's creation of a brand new bureaucracy to limit treatment options -- headed by a political appointee/Czar ironically named "The Commissioner on Healthcare Choices."

Patient safety is entirely ignored in the Senate bill, without a single sentence to reform a medical malpractice system that rewards excessive and unnecessary testing without benefitting those truly injured.

It is a painful disappointment to me to realize that an opportunity to serve American patients has been discarded by those elected to serve.  Instead, we are presented with over 1,000 pages of a reward for political cronies and those who believe that problems in the U.S. health care system stem from a lack of government intrusion into private medical decisions.

$10 billion for labor union bailouts?  It's in there.  New taxes for middle class families the President had promised to spare?  It's in there.  Financially crushing new obligations for small business owners already struggling in a weak economy?  That's also in Senator Baucus's new health care tonic.

So, considering what's being debated on the mainland, I feel lucky and blessed to be serving on this American outpost.

American Samoa has been hit -- and hit hard -- by a series of disasters that challenge the resilience of the Americans who reside on this beautiful but vulnerable island.

But American Samoa's tsunami was not of its own making.  I cannot say the same of the health care reform bill generated by the United States Senate.

Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as the healthcare policy advisor for California's Senator Sam Aanestad while continuing to provide trauma and emergency services in rural communities.
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