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Realizing the True Cost of Obamacare

The New York Times finally decides to spill the beans.

12:00 AM, Jun 4, 2010 • By JEFFREY H. ANDERSON
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Much of the focus on Obamacare has rightly been on its fiscal recklessness.  But in a New York Times story —the type of story the Times couldn’t seem to find space for prior to Obamacare’s passage — we see a clear glimpse of the kind of care that Obamacare would likely spawn.

Realizing the True Cost of Obamacare

With the nomination brewing of Dr. Donald Berwick — a gushing admirer of the British National Health Service — to head Medicare and Medicaid and with Americans already clamoring for repeal in ever-greater numbers, the story, although tardy, is an important one.  It highlights the very real dangers of having millions of the decisions made by doctors and patients across America replaced by the decisions of government administrators in Washington — who rely on studies they don’t understand and pick studies to rely on that aren’t worth understanding. 

In this case, the relied-upon study was completed by Dartmouth researchers, who were thrust into the national limelight by an administration searching to find an angle, any angle, to try to sell its unpopular overhaul.  As the Times writes, “The debate about the Dartmouth work is important because a growing number of health policy researchers are finding that overhauling the nation’s health care system will be far harder and more painful than the Dartmouth work has long suggested.  Cuts, if not made carefully, could cost lives.” 

The Times piece largely stands on its own, and it provides a disturbing account of how much damage powerful government officials could do to people’s lives if they are allowed to impose their decisions nationally, especially when those decisions aren’t rooted — as they almost always wouldn't be adequately rooted — in legitimate empirical evidence in, as President Obama likes to say, “what works.”  Centralizing this much power in the hands of the few would prove fatal not only to liberty but to the quality of American medicine.

The Times writes:

In selling the health care overhaul to Congress, the Obama administration cited a once obscure research group at Dartmouth College to claim that it could not only cut billions in wasteful health care spending but make people healthier by doing so.

Wasteful spending — perhaps $700 billion a year — "does nothing to improve patient health but subjects you and me to tests and procedures that aren’t necessary and are potentially harmful," the president’s budget director, Peter Orszag, wrote in a blog post characteristic of the administration’s argument.

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….

However, the Times writes, “Measures of the quality of care are not part of the formula.”

The Times adds, “For all anyone knows, patients could be dying in far greater numbers in hospitals in the beige regions than hospitals in the brown ones, and Dartmouth’s maps would not pick up that difference. As any shopper knows, cheaper does not always mean better.”

For example, there are “big city hospitals like those at the Ronald Reagan UCLA Medical Center and NYU Langone Medical Center — which look profligate by Dartmouth’s measure but may rank much higher by other quality indicators.”

As the Times shows, the authors of the study seem to conflate higher-quality care and wasteful spending, failing to distinguish between the two — if not in their study itself, then at least in the rhetoric they have chosen in publicly describing it.  The Times writes:

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