Die Cheap For The Sake Of Your Fellow Americans

This piece in the NYT flies in the face of all those who accused us of fear-mongering when we dared call out Congress on the issue of so-called “death panels.” I, for one, was uncomfortable enough with the idea that a gaggle of self-appointed hens in Congress would assess my worthiness and determine whether sufficient resources should be allocated to keep me alive through some horrific medical event. If the Times is to be believed, it is MUCH worse – Hospital budget administrators (under constant attack from Government oversight and regulation to contain costs) will make our life and death decisions for us, and they’ll do so while competing for financial rewards from the Federal Government:

Under the House health care legislation pending in Congress, the Institute of Medicine would conduct a study of the regional variations in Medicare spending to try to determine how to reward hospitals like Mayo for providing more cost-effective care. Hospitals identified as high-cost centers might even be penalized, perhaps receiving lower payments from the government. The Senate bill calls only for studies of Medicare spending variations, so it will be up to House-Senate negotiators to resolve the matter in the final legislation.

That prospect worries Dr. Rosenthal and his U.C.L.A. colleagues, who say that unless the distinction can be clearly drawn between excellence and excess in medical care, efforts to cut wasteful spending could be little more than blunt rationing.

“There’s a real risk of doing harm here — real harm,” he said.

I believe the motto “do no harm” is one of the cornerstones of being a Doctor, but it would seem this healthcare ponzy scheme our Political Heroes are about to approve is going to redefine “harm” from the patient to the pocketbook. Consider WH Budget Director Orszag’s insight:

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

Dr. Rosenthal, along with Dr. John Stobo – senior vice president of University of California Health Sciences & Services co-wrote an Op-Ed in the LA Times back in July titled “Health costs — no quick fix” in an attempt to argue against the Dartmouth approach to analyzing cost. Read this passage closely:

Many news stories and the Obama administration have cited a June article by Dr. Atul Gawande in the New Yorker magazine, as well as research done by the Dartmouth Atlas Project. Both assert that regional variations in Medicare expenditures occur, in great part, as a result of over-utilization of services and procedures. Already, legislation has been introduced in Congress that would reduce Medicare payments to places such as Los Angeles and redistribute the dollars to parts of the country that are deemed “more efficient.”

We agree that every effort should be made to curtail spending that does not show a proven health benefit. However, we disagree that policymakers can extrapolate research data from one region to arrive at conclusions regarding another, very different region. This overly simplistic analysis could have real-world consequences, including further diminishing access for the urban poor and to those middle-class residents who live near pockets of significant poverty.

Investigators from Dartmouth used Medicare bills submitted by doctors and hospitals for patients who died and compared spending across geographies and across hospitals. The theory is that because all the patients died, any variation in spending must be waste. They then extrapolated these findings to identify high-spending geographic regions and high-spending hospitals for all Medicare costs.

Voila: a map in which Minnesota is the paragon and Miami and Los Angeles are the profligates. We dug a little deeper into relevant state health and hospital-use data for Los Angeles County. What we found was quite striking and pointed to one of the key differences in costs and outcomes for healthcare paid by Medicare.

The per capita income in L.A. County is $24,705; in the state of Minnesota, it is $37,373. More than 38% of L.A. County citizens live below the poverty line, 57% are black or Latino, and 24% are uninsured. In Minnesota, 11.6% live at or below the poverty line, 9% are black or Latino, and only 8.8% are uninsured. In L.A. County’s core — Central and South Los Angeles — the differences are even more striking: 56% of the residents are at or below the poverty line, 80% are black or Latino, and 41% are uninsured.

The L.A. core area is definitely not Minnesota, home of the Mayo Clinic, where there appears to be a surfeit of healthy and relatively wealthy patients and a vibrant, integrated healthcare infrastructure. In core poverty corridors, such as South and Central L.A., where there is not excess capacity in terms of beds, emergency departments, nurses and primary-care practitioners, patients are suffering because they have received too little care for too long and arrive at hospitals with multiple health conditions, requiring more extensive, and thus more expensive, care.

It’s stunning that Obama and his healthcare agenda, a thinly veiled attempt to socialize the country’s healthcare system, would ultimately further repress the very demographic he and his minions insist they are trying to save from the rest of us. If the data is to be believed, the only way there will be enough resources for the poor and the minorities in heavily populated areas to receive quality health care is either for them to move to Minnesota, or for the rest of us to buy a bottle of Tylenol and go home and die.