Defending the Dartmouth Atlas

A few days ago, the NYT times wrote a quizzical piece that tried to shoot  holes through the most solid piece of health services research that exists in our country. Problem was, the piece was uninformed and out of context.

But leave it to bloggers to fill in the context and tell the entire story. The Health Wonk Review is coming out later today but I wanted to highlight two excellent posts that set the story straight. The first post is by Maggie Mahar at the Health Beat blog. I would quote some relevant portions but really, the entire post is an excellent read. The second nice post is from Joseph Padua at Managed Care Matters.

The basic point of controversy is the following NYT statement: “Members of Congress are seriously considering proposals to rein in the growth of health spending by taking tens of billions of dollars of Medicare money away from doctors and hospitals in high-cost areas and using it to help cover the uninsured or treat patients in lower-cost regions.” This would have an major impact on my home state of Florida, the poster child of high costs.

But what puzzled me is that this was honestly the first time we had ever heard speculation that Congress was contemplating this policy option, though many of us have argued for a while to “water-down” these cost differentials over time.

Ms. Mahar interviewed Dr. Elliott S. Fisher, one of Dartmouth’s authors, and he stated “If we did, that would only make things worse, not better…In order to keep their incomes steady, doctors would increase the volume of what they do.” Furthermore, MedPAC Chairman Glenn Hackbarth, testified before Congress “But a formula...that attempts to control volume through global payment changes treating all services and physicians alike will produce inequitable results.”

Now, what does this have to do with Medicaid? The answer is…plenty. The same variations that exist in Medicare exist in Medicaid and the same policy option that just about every expert is recommending NOT to do is typically the first tool that states use to balance their budgets - ”across the board” cuts to Medicaid providers. For example, see this recent AP piece, “Doctors balk at Medicaid program,” which highlights recent cuts in Michigan. 

And finally, for those interested in health reform, it would be good to spend a bit of time looking at the actual policies and not listening to people who obviously haven’t looked at the policies (i.e. most politicians). For example, in Ezra Klein’s interview of Jim Cooper (D-TN), who is one of the few member of Congress that understand Medicare/Medicaid, he states “You remember, a few years ago, how Congress didn't know the difference between Sunni and Shi'a? Ask folks about the difference between Medicare and Medicaid, you'd be surprised.” ~BAA