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Monday, June 14, 2010


An article from last week’s New York Times titled, “Study Cited for Health-Cost Cuts Overstated Its Upside, Critics Say,” has stirred up criticism surrounding one of the main pillars Obamacare.

The Obama administration, in its mad push to enact health care reform, made the unbelievable argument that they would pay for reform by simply cutting billions in wasteful health care spending, and that there would be no outcome on the quality of care people receive.

Throughout the course of congressional health care hearings leading up to the health reform passage, as well as in open floor debates, Obamacare advocates would over and over cite to a Dartmouth Atlas College research project, often inviting its authors to testify. Advocates touted the research as if it was definitive proof of their claim – when it was far from it. The compiled research focuses on the spending levels of Medicare patients with a chronic illness who were in their last six months or two years of life.

The Dartmouth research makes the wild claim that it could cuts billions of what it characterized as “wasteful” spending and actually make people healthier. The NYT quotes Dr. Elliott Fisher, a physician who is one of the principal authors of the Dartmouth work writing, “We show where the waste is in medicine. If everyone could operate like Oregon, Seattle or the Upper Midwest, there’s huge savings.”

The NYT points to a key criticism of the compiled research writing,
“But the atlas’s 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 patients could rank lower because Dartmouth compares only costs before death. 'It may be that some places that are spending more are actually getting better results,' said Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale. Failing to receive credit for better care enrages some hospital administrators.”
The systematic New York Times review of varying criticisms is well worth reading. But the short summary is that there is very little evidence to support the Dartmouth conclusion that the nation’s best hospitals are typically the least expensive. In other words, the idea that Americans are in fact getting more for their money remains a valid argument – one that was almost totally ignored throughout the health care debate.

There is reason to remain concerned over this highly criticized Dartmouth research. The NYT writes,
“Dr. Donald Berwick, nominated by President Obama to run Medicare, called it the most important research of its kind in the last quarter-century. In March, in response to the Congressional Democrats who would have otherwise withheld their support for the health legislation, the administration made a promise. It 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.”

This distorted view of the Dartmouth Atlas research could dangerously be institutionalized and used to financially punish hospitals that have high survival rates and improve people’s lives – all in the name of cost.

NRLC has long argued that the cost of health care does not require rationing life-saving treatment (see here). Obamacare advocates wanted to sell the idea that by simply cutting wasteful spending, the expansion could pay for itself. This faulty and gratuitously cited Dartmouth Atlas compiled research gave them cover for that argument – cover that is quickly evaporating. However, when increased health care spending does in fact save lives and increase quality, the administration and new health care law sadly offered no other real long-term way to pay for the kind of quality care Americans deserve.