Stanley Feld M.D.,FACP,MACE
Government spending for Medicare in its present form is unsustainable. Medicare premiums for many seniors are not cheap. Medicare premiums are determined by means testing. The determination includes all income sources such as capital gains, interest income, annuities and pension distributions. Some seniors are paying more than $15,000 a year in after tax dollars for full Medicare coverage. .
President Obama’s goal is universal affordable insurance coverage with increased quality of medical care.
His philosophy is to have the federal government have complete control of the healthcare system.
The weakest stakeholders in the healthcare system are patients and physicians. President Obama cannot control the healthcare insurance industry. He is dependent on the healthcare insurance industry for administrative services. The healthcare insurance industry, plaintiff attorneys and Big Pharma control too much lobby money.
A system of government control of physicians and patients is destined to fail because President Obama is restricting freedom of choice. He is not fixing the problems that caused the dysfunction in the healthcare system. The Massachusetts healthcare reform system has been the perfect example of uncontrolled costs and failure to provide universal coverage and higher quality of care.
One mechanism President Obama is using to achieve his goals in the framework of his philosophy is the proof provided by “medical claims data”.
Medical claims data is worthless in my view. The conclusions from medical claims data have been used against physicians even though it does not provide an accurate view of the quality of medical care. The data does not include risk assessment of patients’ illness or the effect of the physician patient relationship and disease.
Medical claims data does not measure the role of patients’ responsibility for their medical care.
Medical claims data does accurately evaluate the value a physicians’ quality of care.
Healthcare experts concede that even though medical claims data does not provide an accurate picture of the truth it is the best data we have. These experts should try to develop a system that measures the truth before defective policy destined to fail is developed.
I have never understood this logic. It is used as evidence in social science, political science and clinical science. It is extremely easy to reach false conclusions and make the wrong decisions.
Even though the conclusions drawn from medical claims data are mostly inaccurate they are accepted by President Obama and his healthcare team to formulate healthcare policy. Why? The conclusions of the data verify his philosophy.
“In selling the health care overhaul to Congress, the Obama administration cited a once obscure research group Dartmouth Atlas of Health Care at Dartmouth College to claim that it could not only cut billions in wasteful health care spending but make people healthier by doing so.”
Peter Orszag, the president’s budget director has used the Dartmouth Group data to proclaim that perhaps $700 billion a year of wasteful spending — “does nothing to improve patient health but subjects you and me to tests and procedures that aren’t necessary and are potentially harmful,”
“Mr. Orszag even displayed maps produced by Dartmouth researchers that appeared to show where the waste in the system could be found. Beige meant hospitals and regions that offered good, efficient care; chocolate meant bad and inefficient”.
It is difficult to understand what makes Peter Orszag a medical care expert. The Dartmouth medical claims data is quoted without considering that maybe the $700 billion dollars a year is spent on defensive medicine that President Obama refuses to consider.
The Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care. How this conclusion is reached is confusing to me. The Dartmouth researchers themselves acknowledged their medical claims data measure the varying costs of care in the government’s Medicare program and does not include the entire healthcare system. The Dartmouth group has also proclaimed that the data does not measure the quality of care.
Quality medical care has not be defined adequately to date.
“For all anyone knows, patients could be dying in far greater numbers in hospitals in the lower cost regions than hospitals in the higher cost regions, and Dartmouth’s maps would not pick up that difference. As any shopper knows, cheaper does not always mean better.”
Yet President Obama is leaning heavily on the Dartmouth group’s “data to fulfill his goals in the framework of his philosophy.
“President Obama said it would ask the Institute of Medicine, a nongovernment advisory group, to consider ways of putting the Dartmouth findings into action by setting payment rates that would punish inefficient hospitals and reward efficient ones”.
What are other potential defects are in The Dartmouth Atlas of Healthcare data?
- The principal argument behind Dartmouth’s research is that doctors in the Upper Midwest offer consistently better and cheaper care than their counterparts in the South and in big cities, and if Southern and urban doctors would be less greedy and act more like ones in Minnesota, the country would be both healthier and wealthier.
- But the real difference in costs between, say, Houston and Bismarck, N.D., may result less from how doctors work than from how patients live. Houstonians may simply be sicker and poorer than their Bismarck counterparts. Also, nurses in Houston tend to be paid more than those in North Dakota because the cost of living is higher in Houston. Neither patients’ health nor differences in prices are fully considered by the Dartmouth Atlas.
- The Dartmouth Group hospital rankings do not take into account care that prolongs or improves lives. “If one hospital spends a lot on five patients and manages to keep four of them alive, while another spends less on each but all five die, the hospital that saved p
atients could rank lower because Dartmouth compares only costs before death.”
- David Cutler, a professor of economics at Harvard, likens it to failing to account for inflation when looking at gross domestic product. “Nobody in their right mind would talk about G.D.P. growth without adjusting for prices,” he said.
- One example of extrapolation of the data was when Dr. Fisher, in testimony before Congress last year, summarized his and others’ work by asking, “Why are access and quality worse in high-spending regions?”
Many studies have shown no link, either way, between spending and quality. Quality is not being measured by the Dartmouth group by its own admission.
- “There is little evidence to support the widely held view, shaped by the Dartmouth researchers, that the nation’s best hospitals tend to be among the least expensive.”
“In interviews, Dr. Fisher and Mr. Skinner acknowledged that there was no proven link between greater spending and worse health outcomes.
“ And Dr. Fisher acknowledged the apparent inconsistency between his statements in interviews with The New York Times and those made elsewhere, saying that he was sometimes less careful in discussing his team’s research than he should be.”
“In any case, the more-is-worse message has resonated with insurers, whose foundations now help to finance the Dartmouth Atlas.”
The take away point is patients, physicians and hospitals will suffer from the advertised implications of the Dartmouth Atlas’ data. President Obama is using this data to achieve his philosophical goal. The goal is total government control of the healthcare system.