Sarah Palin was right about those death panels, y'know
Okay, so the "standing before a Government Panel, having to defend the life of your baby" is more than a bit hyperbolic, but your creative class betters really do want to cut health care spending by cutting actual care, and they plan to start with the people who depend on Medicare and Medicaid [and the public option too, if that passes].
In his Public Option Undead post below, Lambert linked to this New York Times article criticizing the Dartmouth Atlas. This paragraph struck me:
Dr. Elliott S. Fisher, director of the Center for Health Policy Research at the Dartmouth Institute, said the larger issue was that just because a hospital charges a lot does not mean that it delivers good care. But Dr. Fisher agreed that the current Atlas measures should not be use to set hospital payment rates, and that looking at the care of patients at the end of life provides only limited insight into the quality of care provided to those patients. He said he and his colleagues should not be held responsible for the misinterpretation of their data.
Putting out a white paper titled An Agenda for Change, Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration, authored by Elliott S Fisher and colleagues doesn't constitute even a hint of responsibility for the legislation facing us now? From the preface to the white paper:
Rising health care costs are a major challenge to the American economy, particularly at a time of deepening recession and a renewed commitment to extend coverage to the uninsured. Dartmouth Atlas research on geographic differences in health care delivery and spending points to an opportunity to achieve significant savings in health care costs without compromising health care quality and outcomes. More spending and more utilization do not translate into improved life expectancy for those with chronic illness. The differences in the use of discretionary surgery do not reflect differences in patient preferences and informed patient choice. This paper discusses opportunities for Congress and the Obama Administration to address key shortcomings in our health care system that result in unwarranted geographic variation and uncontrolled growth in health care spending. Success in this effort will not only improve the quality of care, it will make it possible to extend coverage to America’s uninsured without inducing a major increase in health care spending.
This Dartmouth Atlas White Paper was written by John E. Wennberg, Shannon Brownlee, Elliott S. Fisher, Jonathan S. Skinner and James N. Weinstein.
Not only does the legislation [all the bills, from HR 3200 onward] contain pilot programs to demonstrate that less care is more for the chronically ill [those hospitals that provide "more efficient care" read: less care are going to be paid more money], it also contains a pilot program [with no-bid provisions, it looks like] for something called "shared decision making" and "patient decision aids", which is essentially a bunch of professionally-produced materials [videos, booklets, etc] that, although they don't explicitly say so, aim to talk patients out of letting their doctors prescribe more expensive procedures when less expensive procedures will [perhaps] do the same job. These measures [it says so explicitly in the final Senate bill] are to be aimed at "preference-sensitive care", which is a phrase from the Dartmouth Atlas, btw.
This is the second or third time I've seen a Dartmouth Atlas researcher using the newspaper-of-record kinds of venues to distance themselves from the actual legislation and I've wondered why. It can't be because they're expecting to profit from the legislation, by any chance could it? And I mean profit as in collecting actual hard cash, not just in having their reputations burnished as pre-eminent policy scholars.
Jack Wennberg [John E Wennberg] belongs to the Foundation for Informed Medical Decision Making that believes in "informed patient choice" and has even trademarked the phrase "shared decision making". And although you'll find that phrase scattered throughout the proposed legislation, as well as the phrase patient decision aids, nowhere will you see it used as a trademark nor will you see either of these phrases attributed to any particular group, but the language and provisions in the bills are straight out of this foundation's writings and Dartmouth group's papers.
Not to mention that Jack wennberg's son David, who is also part of the Dartmouth Atlas group, works for a company called Health Dialog that produces and sells patient decision aids and also uses proprietary algorithms to help insurers figure which of their [potentially expensive] patients to call up and provide "medical decision coaching" to.
Gee, where have we heard of that "proprietary" crap before? Jonathan Gruber and gaussian copulas come to mind.
Health dialog was sold to the insurance company BUPA a couple of years ago for megabucks. David Wennberg is probably already doing well financially as a member of the senior management team of Health Dialog, but I can't help but think that having his company's main products and services written into the law of the land is anything but continued gravy train for him.
Of course, the legislation is written so that the grants for developing these patient decision aids have to go to a non-profit organization, so Jack Wennberg's foundation will probably be eligible for that money, while Health Dialog will make a killing on selling their materials to doctors and hospitals.
Talk about your death panels, yes, they're in the legislation, even if they're only a collection of nudges toward making you want less care, rather than actual sitting panels that you have to stand before and defend yourself from.