"We have long known that some places...offer high-quality care at costs below average."
--Barak Obama, 09-09-2010, Joint Session of Congress
“[O]ne of the biggest signals of inefficiency in American health care is the massive regional variation in cost and health outcomes…yet the higher cost areas and hospitals don’t generate better outcomes than the lower-cost ones. The result is an estimated $700 billion a year spent on health care that does nothing to improve patient health.”
-- Peter Orszag, OMB blog post, 05-28-2009
It ain't so much the things we don't know that get us into trouble. It's the things we know that just ain't so.
--Josh Billings, and several others
Just over a year ago, I wrote a post on why we need the separation of state and science. The case in point was the use of the research from the Dartmouth Atlas study on regional variation in Medicare costs to claim a 30% reduction in Medicare spending could be achieved if only medical care was centrally controlled to produce more uniform practices. Those conclusions have recently been over-turned.
Dartmouth researchers have associated the unexplained portion of geographic variation with the supply of specialist physicians or hospitals, potentially leading to incorrect inferences about the causes of geographic variation—so-called supplier-induced demand. However, recent studies indicate that health status is a more important factor driving variation in spending than previously believed and that demographic and economic factors, as well as the structure of local health care markets, shape patient preferences and provider practice styles in far more complex ways than early analyses suggested. High spending might reflect inadequately measured health status or some other factor, such as poverty.
This is a point that Buz Cooper has been making all along. These arguments may seem a tad wonky--and I suppose they are--but the crucial issue is that the original findings of the Dartmouth Atlas study were very prominent in justifying the new health care control law--and now it's announced those results were unreliable at best, and more likely just plain wrong.
Read Cooper's whole post for more detail.
Everything the State does, it does by force. Its power, as Mao and Stalin reminded us, comes from the barrwl of a gun.
What good could possibly come from mixing science and coercion? The bad is obvious:
- compromised outcomes
- scientists bought and paid for, like Chicago politicians
- propagating junk in lieue of science
- suppressing actual science which isn't P.C.
- spending billions to discover what private companies would have discovered for thousands
- sucking capital from productive enterprises to study the mating habits of the snail darter
- relative overfunding of AIDS and underfunding of diseases which afflict much larger numbers of people
- filtering for "scientists" who are comfortable working for bureaucrats and with the political process, rather than with, you know, actual, like science
- subjecting entire fields to orthodoxies enforced by a monopoly control over funding
- taking money from unwilling victims by force (i.e. taxpayers) that they would perhaps rather spend on other things
- much much more
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