Peter Orszag and the Obama administration argued for months that cutting health-care spending could make people healthier, by removing ineffective treatments and standardizing approaches to care. They relied on an “obscure” Dartmouth study, using it on several occasions as a substantiation of the ObamaCare approach. The New York Times belatedly discovers that the study actually makes no such claim on qualitative outcomes:
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. …
But while the research compiled in the Dartmouth Atlas of Health Care has been widely interpreted as showing the country’s best and worst care, the Dartmouth researchers themselves acknowledged in interviews that in fact it mainly shows the varying costs of care in the government’s Medicare program. Measures of the quality of care are not part of the formula.
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.
Well, sometimes you have to pass legislation to find out what’s not in it. In this case, what got left out was the qualitative improvements in care promised by the Democrats. In fact, the study actually shows that cuts in health-care funding will more likely lead to poorer outcomes than better ones.
That hasn’t stopped the Obama administration — and one of its most controversial appointees — from continuing to claim that the Dartmouth study corroborates their claims:
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.
But if that system penalizes 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 — a battle over the validity of the Dartmouth work is almost certain in Congress.
In fact, among health policy analysts, that battle has already begun. Critiques have been published in prominent medical journals, and more are on the way.
That’s a safe bet. Berwick has already been targeted for a high-profile confirmation fight, thanks to his public statements lavishing praise on the UK’s single-payer NHS system. His claims over the Dartmouth study will open up a second front and perhaps make Berwick simply untenable as an appointee, just as Dawn Johnsen turned out to be too radical for the White House to support. If the hearings start looking like an open forum on the dishonesty of the representation of the Dartmouth study, expect Berwick to be withdrawn.