Happy Birthday, Medicare! Teh Dartmouth Atlas, some peeps shredz it 4 U!
On July 30, 2013, Medicare will turn 48 years old. To celebrate, I'm outsourcing this post.
From an op-ed in last year's Houston Chronicle, written by a Texas physician, because never forget that Medicare was brought to you by a president from Texas:
It's a birthday that deserves to be celebrated, including here in the Lone Star State. Medicare provides 48 million Americans -- about 3 million of them in Texas -- with reasonably good access to health care, thereby easing their suffering, prolonging their lives, and reducing financial pressures on them and their families. Before Medicare was enacted in 1965, most retired older people were at risk of financial ruin when they got sick. Medicare changed that picture, and our state and nation are much better for it.
But LBJ didn't just recite a spell and wave a magic wand and conjure up Medicare out of mice and pumpkins, he had help. Robert Ball, one of the architects of both Social Security and Medicare, wrote an article giving us a behind-the-scenes look at how Medicare came to be:
How It All Began
What were we hoping to accomplish when we proposed a national hospital insurance plan for the elderly? No other country, as far as I know, had ever considered such an approach. Certainly the elderly were the most expensive and difficult group to cover, and, for the money spent, they clearly would yield the least return of any age group. Why not cover children and pregnant women, as has been discussed from time to time since? That would seem to have made more sense.
A first step toward universal coverage. For persons who are trying to understand what we were up to, the first broad point to keep in mind is that all of us who developed Medicare and fought for it-including Nelson Cruikshank and Lisbeth Schorr of the AFL-CIO and Wilbur Cohen, Alvin
David, Bill’ Fullerton, Art Hess, Ida Merriam, Irv Wolkstein, myself, and others at the Social Security Administration-had been advocates of universal national health insurance.1 We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expected Medicare to be a first step toward universal national health insurance, perhaps with “Kiddicare” as another step.
What's all this got to do with the Dartmouth Atlas? you ask. Not much, except that just in time for Medicare's birthday, the Institute of Medicine released their report
Variation in Health Care Spending: Target Decision Making, Not Geography in which they kinda sorta begin to distance themselves a little bit from the Dartmouth Atlas "research." Because I am a fair and balanced person and an ethical blogger (ha!) I present you with two reviewers' opinions of the report.
Austin Frakt has been a long-time fan of the Dartmouth Atlas researchers and their work, so much so that his first post on the IOM report starts off with a disclaimer that he hasn't yet read it, followed by excerpts from the Dartmouth researchers' rebuttal of the report. You can read what he has to say so far here and here.
Buz Cooper, not-fan of the Dartmouth Atlas, was too polite to title his review "It's the Poverty, Stupid!" so here's a link to IOM says “Target Decision Making.” No. Target Poverty:
So what the report really found, but did not say, was that poverty and its associated poor health status is the major cause of geographic variation in health care and its effect is far greater than apparent from studies of HRRs which, because of aggregation, obfuscate its true magnitude.
If, like me, you like to geek out over some geodata analysis, Cooper provides a link to his (open access!) article Poverty, Wealth, and Health Care Utilization: A Geographic Assessment. Even if you have no intention whatsoever of reading the article, click through just to support the fact that it's open access; your tax dollars paid for that article after all.