Dartmouth Sham (Less Not Better)
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President Obama and his budget director, Peter Orszag, have told seniors not to worry about the funding cuts, claiming that Medicare spending could be cut by as much as 30 percent without doing harm. They cite the Dartmouth Atlas of Health Care 2008, which tried to prove that patients who get less care- fewer hospital days, doctor's visits, and imaging tests- have the same medical "outcomes" as patients who get more care. But read the find print.
The Dartmouth authors arrived at their dubious conclusions by restricting their study to patients who died. They examined what Medicare paid to care for these chronically ill patients in their last two years. By definition, the outcomes were all the same: death. The Dartmouth study didn't consider patients who recovered, left the hospital, and even resumed active lives. It would be important to know whether these patients survived because they received more care.
The journal Circulation addresses that question in its Oct. 20, 2009, issue and disputes the Dartmouth conclusion. Examining patients with heart failure at six California teaching hospitals, doctors found that hospitals giving
SEC. 4105(a). EVIDENCE BASED COVERAGE OF PREVENTIVE SERVICES IN MEDICARE.
(n) AUTHORITY TO MODIFY OR ELIMINATE COVERAGE OF CERTAIN PREVENTIVE SERVICES.- Notwithstanding any other provision of this title, effective beginning on January 1, 2010, if the Secretary determines appropriate, the Secretary may-
(I) modify-
(A) the coverage of any preventive service described in subparagraph (A) of section 1861(ddd)(3) to the extent that such modification is consistent with the recommendations of the United States Preventive Services Task Force...
more care saved more lives. In hospitals that spent less, patients had a smaller chance of survival. That's the opposite of what Obama claims.
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