The Most Dangerous Thing in American Health Care is Barack Obama Carrying the Dartmouth Atlas
President Obama spent last weekend excited by Atul Gawande’s article in the New Yorker. In it, Dr. Gawande travelled to McAllen, Texas, one of those places where health care is very expensive and not very effective. Dr. Gawande put a human face on the research contained in the Dartmouth Atlas and related publications produced by a team of scholars that has spent decades documenting variances in health spending and outcomes across the U.S. The White House has promoted the simple idea that if “we” could make the worst performing areas meet the standards of the best performing areas, “we” would reduce spending by 30 percent without harming patient outcomes.
Unsurprisingly, President Obama traveled to the polar opposite of McAllen: Green Bay, Wisconsin. At a rally of the faithful, Mr. Obama proclaimed that “we” is the federal government. Through various levers (especially health IT, a boondoggle for high-tech companies), his health reforms would bring the whole country up to the health care standard of this high-quality, low-spending community.
The Obama White House has succumbed to the fundamental fallacy of socialism: believing that the government can collect information, analyze it and then command its citizens to act in accordance with the government’s conclusions. In this case, the information is the Dartmouth Atlas, a well-known body of research that documents variance in Medicare spending and outcomes across the country. While places like Green Bay demonstrate low spending and high quality, places like Miami or Los Angeles demonstrate the opposite.
Advocates of the practice of medicine by government dramatically oversimplify the implications of the Dartmouth research, claiming that the variance is caused by too much medical care delivered to patients who actually suffer from it. If the government just commanded all medical providers to deliver the same volume of care nationwide, we’d cut health spending by 30 percent.
Oh, really? If President Obama believes that he’s got enough charm to convince Miami’s seniors that Medicare is going to cut back their access to care by 30 percent (sorry, we’ve already done all the coronary artery bypass grafts allocated to this ZIP code for this year), then he’s got political guts – that’s for sure.
Nor are scholars united on the reason for the variance, which is unexplained by medical necessity. The Dartmouth researchers lean towards provider-side reasons. Like most academics, they tend to dismiss the idea that patients “demand” health care. Instead, they do what their doctors tell them. So, the volume of care delivered depends on doctors’ financial incentives and their local culture (for example, following the doctors from whom they have learned).
But the truth is more complex. Greg Scandlen, currently a health policy analyst, was working at Blue Cross Blue Shield of Maine, the source of much of the original data. The data indicated that women in Lewiston, Maine were something like three or four times more likely to get a hysterectomy in their lifetimes than were women in Wiscasset, just thirty miles away. Mr. Scandlen points out that Lewiston was heavily French Canadian and Roman Catholic, while Wiscasset was almost entirely Yankee Protestant, concluding that women in Lewiston were using hysterectomies as a form of birth control after having six or more children.
Furthermore, in the journal Health Affairs, Dr. Richard Cooper analyzed data which included private health spending, as well as Medicare spending, and concluded that more spending did result in better outcomes. Dr. Cooper’s findings indicate that it is the centrally controlled Medicare program that has trouble paying for quality, not the 1,800 private insurers that compete against it.
Health care is far too complex for a central government planner to reduce costs without harming quality, in a quest to “cover the uninsured.” Greater choice and higher quality in health care will come from less government control, not more.
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If greater choice and higher quality will resullt from less gov’t. control, not more, when will private insurors update the seriously obsolete model for all present health care, based on diagnosing symptoms? This does not work for chronic disease, since symptoms emerge after 20 years of full-body damage caused by poor lifestyle. Thus, 85% of all health costs are completely unnecessary, if a new model is adopted that urgently and forcefully addresses poor lifestyle choices.
This is easily and cheaply done. See my site, freehealthreform.com .
The advantage of a gov’t. option is that it could be a research arm of CDC, enrolling underserved people who don’t have the option to “walk” to another plan if they are asked to use some effort towards personal responsibility for health. Then, the private sector would gain a cultural mandate for change, and the health crisis is solved.