First do no harm: last year there wasn't a single fatal airline accident in the developed world. So why is the U.S. Health Care System still accidently killing hundreds of thousands? the answer is a lack of transparency.

• Author: Allen, Marshall
• Position: Report

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Georgeanne Mumm's surgeon emerged from the operating room with welcome news for her worried family. He had removed her cancerous kidney, he said, and her outlook looked good.

The surgeon failed to mention, however, that he also had accidentally removed part of her pancreas, having mistaken it for a tumor. Nor did he mention that he had inadvertently cut the blood flow to her spleen, damaging it irrevocably. Only an emergency operation by another doctor the next day kept Georgeanne from dying right then and there.

Now the fifty-six-year-old Mumm sits alone in her trailer in rural Nevada. She is unable to work due to her disability but is still on the hook for about $300,000 in medical expenses related to her disastrous contact with the U.S. health care system.

Why do we keep hearing stories like this? Twelve years ago, the Institute of Medicine issued a landmark report showing that medical errors in U.S. hospitals kill up to 98,000 Americans a year. In 2000, another estimate, published in the Journal of the American Medical Association, which included fatalities resulting from unnecessary surgery, hospital-acquired infections, and other instances of harmful medical practice, put the total annual death toll at 250,000.

By that figure, contact with the U.S. health care system was the third leading cause of death in the United States, just behind all heart disease and all cancer. People responded to the alarm. Task forces were convened, congressional investigations launched, op-eds written. Yet as hard as it may be to believe, American medicine is, if anything, even more dangerous today.

In November 2010, the U.S. Department of Health and Human Services issued a study that covered just the 15 percent of the U.S. population enrolled in Medicare. It found that each month one out of seven Medicare hospital patients is injured-and an estimated 15,000 are killed--by harmful medical practice. Treating the consequences of medical errors cost Medicare a full $324 million in October 2008 alone, or 3.5 percent of all Medicare expenditures for inpatient care. Another recent study looked at the incidence of avoidable medical errors across the entire population and concluded that they affected 1.5 million people and cost the U.S. economy $19.5 billion in 2008. The Centers for Disease Control and Prevention have estimated that almost 100,000 Americans now die from hospital-acquired infections alone, and that most of these are preventable.

People like Carole LaRocca are the human face of this travesty. One day recently I sat at the seventy-four-year-old's kitchen table as she broke down in tears. She was weeping not because of the hospital-acquired infection that almost took her life, but because of the $3,676 bill she faced for the antibiotics she needed to treat the harm done to her by her hospital stay. Every month she pays $25 of her meager fixed income toward the debt, and is still hounded by bill collectors.

A cynic might say it's no surprise that American medicine fails to put safety first, since doctors and hospitals often make money by treating those they injure. There is, however, also a deeper and more systematic reason for the continuing toll of injury and death caused by the U.S. health care system: we don't know who's failing and who's succeeding. Plenty of U.S. hospitals have dramatically improved their safety performance. The best have virtually eliminated the deadliest hospital-acquired infections, even as lethal microbes have evolved to become more contagious and resistant to treatment. If every health care provider adhered to the highest standards of patient safety and evidence-based medicine, hundreds of thousands of lives could be saved, to say nothing of the billions of dollars spent on treating complications--but good luck discovering for yourself which hospitals are safe and effective and which aren't.

That's because the public, the payers, and the providers themselves typically lack access to the data necessary to make such a life-and-death determination. In the airline industry, if a pilot so much as accidentally makes a wrong turn moving away from the gate, anywhere in the world, the event is instantly recorded in global databases and scrutinized by government agencies and the industry itself, The knowledge gained from this continuous process leads to big and little changes in aviation protocol, equipment, and personnel. As a result, there was not a single airline fatality anywhere in the developed world last year.

In health care, by contrast, patient safety experts often remark that the death toll from medical errors in U.S. hospitals is equivalent to three jumbo jets falling out of the sky and killing all the passengers on board every forty-eight hours. But even the most egregious errors go largely unreported, and when they are reported, they are often buried and ignored. For the most part, all the public gets to hear about are industry-wide estimates and statistical averages of the kind presented above. Because we lack specific knowledge of where these injuries are...