Ronald Dworkin, an anesthesiologist editorializing on Health Care Reform in the Wall Street Journal last Thursday, identified one very key impact of Obamacare which would guarantee the degradation of quality of American health care.

(US Health Care today) unites rich and poor in a common private insurance system.

Here’s how it works. When a rich person rolls into the operating room, the nurse asks him: “Would you like a warm blanket? How about a pillow?” The anesthesiologist numbs his skin before putting in the I.V. Every effort is made to make him happy.

People in the operating room pay attention to a rich patient’s wishes because they know a rich person can make their lives miserable. He can complain to the hospital president, or call the mayor. But the side effect is that their high quality care becomes habitual, and all patients receive it. When a poor person complains in most environments, no one listens. But in health care, through a common private insurance system, poor people go to the same hospitals and doctors as rich people and thus enjoy the benefit of rich people’s power.

The public option severs this link. Dissatisfied with government-run health care, the rich will exit the system. The poor and middle-class will be left to flounder alone inside the public system. Government-run health care will become like the public schools.

The best doctors will be opening luxury clinics in Carribean resort locations, and the wealthy will simply jet off for their health care, leaving everyone else experiencing the equivalent of inner city hospital emergency room service, endless queues, drastic rationing and triage.