Today’s NYT’s on the Dartmouth Research

Today’s New York Times tries to tell a story at the very center of what is shaping up as a stormy debate over  just how much waste there is in our healthcare system.   But while striving to be even-handed,  the Times quotes both informed and uninformed sources—sometimes taking informed sources out of context—and in the process, makes hash of the facts.

The Times begins by reporting that the New Yorker article that I wrote about last week “has become required reading in the White House.” This story, by Dr. Atul Gawande, describes pricey and potentially harmful overtreatment of patients in McAllen, Texas, where Medicare spends more, per capita, than in any other town in the country.  The data behind the story comes from more than two decades of Dartmouth research showing “widespread and unwarranted variations” in how much care very similar patients receive in different parts of the country.  

The Times explains that the Dartmouth research focuses a “problem that intrigues the President very much . . . the huge geographic variations in Medicare spending per beneficiary.” What’s shocking is that “the higher spending does not produce better results for patients.” The paper goes on to quote Senator Ron Wyden (D. Oregon): The president “came into a [recent] meeting with that article having affected his thinking dramatically. He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix.’”

Reminder: NY Premiere of Money-Driven Medicine This Thursday (Clip from the Film Below)

Alex Gibney, best known for his 2005 film, Enron: The Smartest Guys in the Room  and his 2007 Academy Award Winning documentary, Taxi to the Dark Side has made a 90 minute documentary of my book, Money-Driven Medicine: The Real Reason Health Care Costs So Much

The Century Foundation and the New York Society for Ethical Culture are co-hosting the New York premiere on June11,  7p.m.  at the New York Society for Ethical Culture, 2 West 64th Street at Central Park West. Doors open at 6:30.  Admission is free.  If you’re planning to attend, please RSVP  Loretta Ahlrich ahlrich@tcf.org  or (212) 452-7722 so that we can have a rough idea of how many people will be coming.

Alex Gibney will be there, and following the screening, he will take questions about film-making and I’ll answer questions from the audience about healthcare and healthcare reform.  
Here’s a clip of the opening sequence of the film: 

Quote of the Day

Grazing online, I ran into this remark by Princeton health care economist Uwe Reinhardt.  Talking about “the essential difference between Americans and peoples elsewhere,” Reinhardt quotes author Ian Morrison: “In other countries, having health insurance is a right while owning a gun is a privilege. In the U.S. it is the other way around.” 
With that in mind, Morrison defines Canadians as “unarmed North Americans with health insurance.”
(Reinhardt describes Morrison as “a latter-day de Tocqueville.” Hat tip to the National Journal online where Reinhardt’s remark appeared.)

 
   

“No Chance”—A Surgeon’s Tale

This week-end, I stumbled upon a story written by “BuckEye Surgeon” (Jeffrey Parks),  a general surgeon in Cleveland, Ohio that I found provocative.  Parks wrote the post back in 2007, but it’s just as relevant today as it was then.
The piece, which is titled “No Chance” describes how and why Buckeye operated on a patient who he knew had no hope of surviving. Whether or not this patient had an operation, he  was going to die. The post raises medical ethical questions, and reminds us that in the messy reality of hospitals—where human beings are suffering and dying—the answers are not always so clear-cut. I think BuckEye surgeon was brave to tell this story and that he tells it very well. Did he do the right thing?  I’m not a surgeon, so I’m not going to try to second-guess the physicians who read this blog. But I would say, from a patient’s point of view, if I (or a loved one),  had been the patient, I would be glad that Buckeye did what he did—for the reasons that he gives.  But I suspect I may not be in the majority on this one. Click here to read the post.
What do you think?

Medicare Reform—“MedPac on Steroids” Part 1: An Exciting Proposal

HealthBeat has long argued that Medicare reform will pave the way for healthcare reform, and that the Medicare Payment Advisory Commission’s (MedPac’s) recommendations could serve as a brilliant blue print for overhauling Medicare.  (Also see our Century Foundation report on Getting More Value From Medicare).

Now President Obama appears to be backing a proposal that would empower MedPac to realize its vision for reform.  Yesterday, in a White House meeting with Senate Democrats, the president  reportedly “went out of his way” to mention a bill, introduced by Senator Jay Rockefeller ( D-W.Va)  that would move decisions about Medicare benefits away from Congress, by turning MedPAC into an independent executive agency.  Currently, MedPac is an independent panel that advises Congress. It has no formal power. But under Rockefeller’s bill it would be able to implement its recommendations and fund policy initiatives.

President Obama: “I strongly believe that Americans should have the choice of a public health insurance option”

In a letter to Senators Ted Kennedy and Max Baucus that the White House just released this afternoon, President Obama spelled out his vision for health care reform, making it clear that he wants a public sector alternative to private insurance: “operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.”  (Hat Tip to Jonathan Cohn, over at The Treatment  for calling attention to this letter.

So much for speculation that the administration would back down on this issue.

The President also is “putting another $200 to $300 billion on the table,” Cohn notes, “proposing to extract that money from savings in Medicare and Medicaid.” He pairs the offer with a proposal he talked about yesterday that would give the Medicare Payment Advisory Commission (MedPac) the power to implement its recommendations for Medicare reform. (MedPac is an independent panel that advises Congress on Medicare Spending and under legislation sponsored by Senator Jay Rockefeller, MedPac would have authority to set fee schedules for both hospitals and doctors.)

Dr. Atul Gawande and the Fight for the Soul of American Medicine—Part 2 : Why It Does Matter Who Pays For Care

Did you know that in the U.S. more people die each year from the complications of surgery than die in car accidents?  This is one of many stunning facts that Atul Gawande reveals in his most recent contribution to the New Yorker, “The Cost Conundrum.”

He elaborates: “In recent years, we doctors have markedly increased the number of operations we do. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely.”

In Part I of this post , I described what Gawande discovered when he visited McAllen Texas, home to the most expensive health care in the world.  First, he asked, why is care in McAllen so costly?  The answer: Volume.  The citizens of this poor Rio Grande town receive “more of everything”—more diagnostic testing, more hospitalizations, more surgery, more home care.

The Death of a Doctor: Finding “Common Ground” on Abortion is Not Likely

With a single bullet, the killing of Dr. George Tiller, an abortion provider in Wichita, Kansas, made the process of finding “common ground” in the abortion debate much more difficult.

As much as President Obama has been talking up conciliation, the rhetoric and ideology espoused by some abortion foes makes it almost impossible to work toward a national reconciliation on abortion and freedom of choice. So far, seven abortion clinic workers and doctors have been murdered by right-to-life extremists since 1994. More than a dozen clinics have been bombed over the last fifteen years and many others have suffered vandalism and near-constant threats of violence. These acts of violence are condemned by traditional right-to-life groups and conservatives, but the level of rancor coming from many of these groups serves to incite the acts nonetheless.

In my previous post I mention that there is a severe shortage of doctors who will provide abortions. This killing will make that shortage even direr—a goal that abortion foes have actively pursued.