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ObamaCare Guided by Price Irrespective of Outcome

John on June 3, 2010 at 1:27 pm

The NY Times has a must read story today by Reed Abelson and Gardiner Harris. It points out that some of the data used by the Obama administration to sell the country on ObamaCare has some serious shortcomings. The focus of the story is the Dartmouth Atlas of Health Care which produced this map:

Red regions represent areas of high Medicare spending, yellow regions of lower spending. This map was featured in CBO Director Peter Orszag’s testimony to Congress in 2007. Orszag went on to become Obama’s budget director. The Dartmouth work is also highly favored by Dr. Berwick, recently picked by the President to administer Medicare. So what’s the problem? The data looks at spending not at outcomes:

Dartmouth ranks hospitals only by costs and number of treatments and procedures. A different picture emerges from work done by the Wisconsin Collaborative for Healthcare Quality, a voluntary group of health care organizations that uses both price and quality of care measures. In an analysis of heart attack care, for example, it ranks Bellin second, and St. Mary’s 15th, among the 22 hospitals in the state.

And a Medicare ranking based on its own data that shows how many people die after treatment for certain conditions — statistics that exclude costs entirely — puts Bellin fifth, but drops St. Mary’s to second-to-last: 67th of the 68 hospitals statewide that were measured by both Dartmouth and Medicare.

Do the Green Bay hospitals favored by Dartmouth really offer better care? Maybe not.

Have a look at this chart (click for full size):

The ranking on the left is the Dartmouth ranking. So Riverside Medical Center received top place, meaning they spent the least money on end of life care in the state. The 11th place (out of 68, so this is still a top performer) went to St. Mary’s Hospital.

Now look at the ranking on the far right. That’s the mortality ranking of the same hospitals, from 1 to 68. So you’ll notice immediately that the hospital which came out #1 in the Dartmouth ranking came out #66 (of 68) in the mortality ranking. Now look at Dartmouth’s #11, St. Mary’s. That hospital actually came out #67, making it the second worst in the list. What does all this mean? Well, sticking just to the data at hand, it seems to show that the Dartmouth rankings are rewarding some of the worst performing hospitals in the state because they are cheap. Saving money is given precedence over preserving lives.

For the record, it’s not clear that this holds true in every state and it does seem as if the Dartmouth authors are trying to address the issue of outcomes. So I am not suggesting that we can just ignore the results of their work entirely. However, relying on experts to set national policy, especially end of life health care policy, always presents a danger. Put simply, what if the experts get it wrong? They certainly seem to have done so in Wisconsin. Scream all you want, but if we allow experts to reward hospitals for saving money regardless of the lives they lose in the process, we’re well on the road to death panels.

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