If you have "no place to go," come here!

Happy Birthday, Medicare! Teh Dartmouth Atlas, I shredz it 4 U!

A lolcat GIFt for you, because the Dartmouth Atlas "researchers" really ought to be laughed off the face of the earth, for this, if for no other reason:

By looking at care delivered during fixed intervals of time prior to death, we can say with assurance that the prognosis of all the patients in the cohort is identical -- all were dead after the interval of observation.

SRSLY. They said that. Just because these people all died at the same time, they were all equally sick while they were still alive. WTFBBQeleventyone?!

Granted, they were talking about patients with chronic illness, which does narrow the scope of the stupid a bit, but not much.

And from this non-fact, they go on to aver, which they have done for decades, that the extra care -- and therefore the extra expense -- that was lavished on the most expensive of these dead people (yes it's true that some dead people do turn out to be more expensive than others) was wasted.

And why do we waste money on dead people? Because we have too many specialists and traditional Medicare has a fee-for-service payment system:

In the absence of evidence, the prevailing cultural assumption that more medical care is better takes hold, leading physicians unconsciously to use available resource capacity up to the point of its exhaustion. This assumption is amplified in a fee-for-service environment that pays providers more for doing more.
The per capita utilization of this type of care is strongly correlated with the capacity of local regions and hospitals. For example, we have shown that half of the regional variation associated with hospitalizations for medical conditions, visits to medical specialists, and the use of coronary angiography can be explained by the per capita supply of beds, specialists, and angiography units.

Well, since July 1st is Canada Day, I'll point out that even the denizens of Wonkblog are (belatedly) allowed to note this much:

While Canada’s health care system is publicly financed, many providers are not government employees. Instead, doctors are usually reimbursed by the government at a negotiated fee-for-service rate. The average primary care doctor in Canada earns $125,000 (in the United States, that number stands at $186,000).

Gee, looks kinda like more fee-for-service would be a good thing.

Of course, it wouldn't be Wonkblog if they couldn't find something scary bad to say about a liberal solution to a social problem, and so they raise the specter of waiting times (see: think tank, libertarian):

Where Canada does not do well is on wait times, which tend to be longer than in other countries, especially to see specialists or obtain an elective surgery. A Commonwealth Fund survey in 2010 found that 59 percent of respondents reported waiting more than four weeks for an appointment with a specialist, more than double the number in the United States:

The implication being that Medicare for All would automagickally result in huge lines to see a specialist if you needed one. We have low waiting times for specialists because we have more specialists than Canada does, not because Medicare for All would disappear them all to Mars.

Oh, and as for that too much care meme:

Regarding your editorial on end-of-life care and the findings of the Dartmouth Atlas, (“End-of-Life Care and Costs,” June 18) a few observations are in order about the continuing high cost of health care.

Some people blame overutilization, and by extension blame fee-for-service by saying that it encourages physicians to order more procedures. This is a straw man that needs to be put to rest. In Europe, with much lower costs per capita (and longer life expectancies) utilization rates are actually higher than in the United States.

That editorial would be here: should you care to read it.

Thus marks the beginning of a month of posts dedicated to shredding the Dartmouth Atlas, before the Dartmouth Atlas ideologues can shred Medicare (although they've got a head start on me).

Average: 5 (1 vote)


Submitted by lambert on

Couldn't hurt for at least this member of the peanut gallery to have that dead people methodology thing explained -- probably with a link to something you've already written. Just to deal with that "Waid, they said that?" reaction....

Submitted by hipparchia on

that's a topic that's slated to get its own post, and shortly (tomorrow night maybe; tonight would be good but i don't have all my ducks in a row yet, and yes i was planning to cannibalize some of my earlier writings).

katiebird's picture
Submitted by katiebird on

The value and rewards of so-called "end of life care" is something my family has all to much experience with through my mom's medical experience. Here is just one of the success stories - told by her in a Letter to the Editor of the New York Times:

To the Editor:

I am a 30-year survivor of stage 4 colon cancer with three tumors in my liver. I was fortunate in going to M. D. Anderson Cancer Center in Houston.

Local doctors had given me two years to live. In Houston, they tried every possible procedure, including high-energy radiation, direct arterial chemo infusion to the liver, an immune system stimulant and finally surgery to remove the remaining shrunken tumor.

Some surgeons choose not to operate if they think they have a poor chance of saving you. But the decision should be primarily yours.

I urge anyone who receives a diagnosis of cancer to go immediately to a major, recognized cancer center. Don't wait for your local doctor's approval.

Her surgeon read that letter, remembered her & was so thrilled to learn she was still alive and well that he tracked her down and they talked for almost an hour!

Wonkblog can poo-poo the value of such care -- all but say that there IS no value to it.... but, the fact is they can save lives where it used to be impossible.

Submitted by hipparchia on

yep, we do have a lot of that here, don't we.

but even if EVERYBODY in the usa -- including visitors, immigrants, undocumented workers, everybody -- were given free access to good health care, we'd still have more specialists per capita than most countries and we would still have shorter wait times than most countries.

Rainbow Girl's picture
Submitted by Rainbow Girl on

I'm not a scientist or a statistician or a social economist but I wonder if the number of uninsured Americans that (in the pre-Election years) Obama claimed that PPACA would cover would not be a good proxy for how many people *do not even get to stand in a line* to see a specialist precisely because uninsured. I would wager, for example, that very few (none of?) the residents in those very poor counties in Mississippi that no insurer has signed up for (as part of Obama's "marketplaces") have even considered the possibility of seeing a specialist. Multiply that by all similarly situated citizens in the US ...

Between what Hipparchia said -- that we have more specialists in the US than in Canada to begin with -- and the possibly very high number of US people who never go to a specialist because uninsured or underinsured, that "argument" about "overutilization" of specialists in the US and how Canada has a "long wait issue" is cracked wide open and revealed to be utter bunk.

Aeryl's picture
Submitted by Aeryl on

Another thing to remember, is what's being compared in those statements about specialists, are hip replacements.

In America the wait time for hip replacements is a lot shorter. But guess what covers most hip replacements? Medicare. It is one of the few times, when comparing Canadian healthcare to American healthcare is actually comparing apples to apples(socialized healthcare to socialized healthcare). And it shows that socialized health care can be done RIGHT!!!

Submitted by hipparchia on

And it shows that socialized health care can be done RIGHT!!!

it sure does!

our medicare is better than canada's medicare actually, in some respects, at least traditional medicare is. it's fully nationwide, with all doctors and hospitals accepted, none of this in-network/out-of-network stuff to worry about.

canada's medicare is kind of like our medicaid, with each province required to cover certain kinds of care in order to get federal money but also allowed to offer additional care, so care and coverage vary from province to province a bit. also, since the provinces are the payers, when you get sick while traveling outside of your home province there, you essentially have to go to an out-of-network doctor or hospital. fortunately for canada, their interprovincial agreements on this sort of thing are fairly well worked out, and patients don't languish around in waiting rooms while insurers and providers haggle over payment. mostly it just adds to some of the administrative overhead to do things that way.

Submitted by lambert on

... taking down their main points in the captions, plus the map, might be an unbeatable combination, visually. Could be fun. Cats always work!

Submitted by hipparchia on

my original plan was to have at least one lolcat and one map/chart/graph/table/otherdatavisualization per post, but i think that not all of them are going to lend themselves to lols.

but yes, i did go through all the cheezburger sites and bookmark a lot of lolcats (and dogs, and hedgehogs, and ...) for possible inclusion.

Rainbow Girl's picture
Submitted by Rainbow Girl on

We could use Lambert's blogroll and sites from Alexa's great PPACA resources section to email-forward each of your posts (with Lolcatz + Map) to appropriate sites that accept comments.

Submitted by lambert on

.... so I would encourage a lolcat for every post. It's such a superlative piece of branding and will make the series easier to propagate and keep people coming back. Also, if we create ebook from the series, they can become the opening page to chapters/posts.