As a family physician for nearly 30 years, specializing in wellness and prevention of disease, and as a doctor who has worked in an economically compromised community in Tucson, I feel that it is my duty to my community and to my country that I warn the President and the Congress of what will happen if they chose to implement "Obamacare."

In the early 1980s, Tucson, along with Minneapolis, became a "test city" for the nascent HMO system. I sat with a group of doctors and was told that if we didn't join the HMO community, we took the risk of losing our practice as patients left their individual insurers and moved over to the HMO system through their employers. Over the years, I witnessed some of Tucson's finest cardiologists, OB / GYNs, nephrologists, MDs and DOs alike leave Tucson so that they could carry on private practice in freer markets. I myself have resisted the temptation to obligate myself to the various HMOs and PPOs that have become commonplace in Tucson.

Instead of doctors getting fees for service, those who have succumbed to the HMO system are forced to accept "discounted" fees created by HMO bureaucrats. These fees were so discounted that many doctors simply couldn't survive without sacrificing patient care. In some HMOs today, doctors still have difficulty getting needed diagnostic modalities (e.g. MRI, CT scanning, etc.) because of HMO requirements based on price, not quality of care. This causes delays in diagnosis, delays in treatment, and denial of certain pharmaceutical prescriptions. To say it bluntly, in many cases, HMO bureaucracy has lead to death.

In my 30 years of practicing medicine, I have travelled around the world and have observed Obamacare-type medical systems from both the patients' and the doctors' perspectives. In almost every case, the results were long waits for basic treatments that are common here, under our private system. These include, for example, surgical procedures, such as knee or hip replacements, delayed or denied on massive scale and delay or lack of treatment for people with respiratory or gastrointestinal disorders.

In addition, the cost of government intervention in more nationalized (socialized) systems extends to a lack of motivation for pharmaceutical companies and other firms that produce diagnostic and therapeutic instrumentation to create new, more progressive, state of the art products. Observing these nationalized health systems around the world has made me realize how much worse our medical system can, in fact, become.

By putting government pressure on the current medical market, the most progressive treatment would only be available to the wealthy, leaving the middle class and the poor to suffer increased morbidity (debilitating illness) and mortality. Even under our less than perfect current system, the middle class and the poor are able to receive necessary treatment, including most medical and surgical procedures, in order to sustain their life and restore them to a degree of wellness.

In conclusion, while I would supposedly benefit financially under Obamacare, as a wellness and prevention specialist, I find that my silence in this matter would be hypocritical. I urge Congress and the President to strongly reconsider turning our medical system into one that leaves the access to the best healthcare in the hands of only the wealthiest Americans.

Dr. Kwasman's Golden West Medical Center has been specializing in wellness and prevention for patients in Southern Arizona since 1980.

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