Happy Birthday, Medicare! Teh Dartmouth Atlas, I shredz it 4 U!
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: http://www.vnews.com/opinion/7036218-95/editorial-end-of-life-care-and-c... 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).