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There is a local buzz to the health care debate. Grand Junction has popped up in the current national health care discussion and President Obama has been invited to visit. Local eyes are filling with stars and giddiness is growing. Unfortunately, in all the excitement certain facts are being manipulated by individuals who claim to speak for all. Perhaps it's time for a deep breath and some perspective.
Here is the sequence of events. First, a large study done at Dartmouth University looking at variations in Medicare spending was released in April 2008. More recently Dr. Atul Gawande, an Ivy League surgeon, wondered in the June 1 issue of The New Yorker magazine why McAllen, Texas, had one of the nation's highest levels of Medicare spending. Grand Junction's name came up in that article as one of the lowest spending regions.
Now, President Obama's team is using the Dartmouth study to leverage advancement of the Democrat party's health care proposal. Lastly, Dr. Michael Pramenko has hailed the virtues of our local health care in his recent column in the GJ Free Press in response to Dr. Gawande's article. Given the tremendous implications for all of us, I think this sequence is worthy of closer scrutiny.
The Dartmouth Atlas is being overstated. To briefly recap, the researchers collected data concerning Medicare spending during a person's last two years by looking backward after death. Expenditures were analyzed by hospital and geographical region. There was wide variation between individual hospitals and regions. Per capita hospital costs ranged from $13,706 (Dubuque, Iowa) to $51,917 (Manhattan, N.Y.).
Grand Junction came in at $14,739 while McAllen came in at $33,729. What the data did not provide was an explanation for these differences. The data also did not show whether these differences in spending had anything to do with the quality of the health care or any outcome other than death.
All the data showed is that some hospitals spent more than others. As such, this study could serve as a starting point for further research, not as a measure of how to model health care delivery for the nation as a whole. Now let me rephrase this in case you weren't paying attention. The death rate in this particular study was 100 percent. Yes, you read that right, every single patient analyzed in this study died! The only logical conclusion to be made is that Grand Junction is efficient at getting people to the point of death.
Hang on to your wallet, because the Dartmouth Atlas will now be touted as showing that some regions (Grand Junction being the shining example) are “more efficient” at delivering health care while saving money! This in turn will serve as the anvil upon which health care spending throughout the country will be hammered into line by a federally controlled health care system. In fact, the Dartmouth study reveals absolutely nothing about efficiency. Determining “efficiency” will require looking at end points other than death, and will include individual interpretations of value, quality and lifestyle. But those things are much more difficult to measure, so we are about to be treated to an example of using data wrongly to support a wrong-headed argument.
After listening to President Obama speak at ABC TV's recent health care forum, I was saddened to hear the leader of this country say the following when asked about a 100-year-old woman receiving a pacemaker.
“I don't think that we can make judgments based on peoples' spirit. That would be a pretty subjective decision to be making.”
Well, here's a little news flash for everyone. Doctors and patients make decisions every single day based on peoples' spirit, desires, values, individual preferences and all those other things that are so difficult to measure and regulate, but that define the human experience.
The current administration advocates a system that will take those difficult value judgments out of your hands and put them in the hands of a nice, caring, compassionate bureaucrat. If one could practice medicine by a cookbook approach, we would not need more family physicians, we would need fewer, because a simple computer program could do the job. But it just is not that simple.
President Obama went on to say: “I don't want bureaucracies making those decisions, but understand that those decisions are already being made in one way or another. If they're not being made under Medicare and Medicaid, they're being made by private insurers.”
He then added: “Maybe you're better off not having the surgery, but taking the painkiller.”
Health care services are finite, just like any other commodity. At its core, the entire health care debate boils down to distributing a finite number of dollars for the purchase of health care services for a diverse population of 300 million. The only way to do that is by allocating expenditures and resources, or in other words rationing.
Whether you know it or not, rationing takes place every day. Are you really getting full information about costs, benefits and options when you talk with your doctor? You might be surprised at what you are not being told. Is your doctor advocating for you, or for the insurance company? Are you being steered away from costlier options solely due to cost? The common thread between Dr. Pramenko's and President Obama's comments is that both are trying to reduce this complex problem into a simple financial equation. Once that happens, the dollar amount becomes the overriding concern. The (barely) unspoken message is that you have a duty to die cheaply in order to save money for everybody else.
Let me just add one parting thought. Any parlor magician hopes the audience is not really paying attention, so that the coin can be palmed undetected. I challenge others in this community to expose the sleight of hand. Now is not the time to be silent. I do not speak for everyone any more than Dr. Pramenko does. I would love to hear from others who are able to think independently. That is something the rest of the nation can emulate!
--------------------------------------------
Dr. Schroeder is a practicing pediatric cardiologist currently living and working in Grand Junction. He has previously practiced medicine in the military for 13 years and in San Antonio, Texas, for eight years. He attended Palisade High School. He attended college at West Point and the University of Colorado and medical school at Tulane University in New Orleans. Schroeder cares deeply about the future of his profession and the future his grandchildren will inherit.
Here is the sequence of events. First, a large study done at Dartmouth University looking at variations in Medicare spending was released in April 2008. More recently Dr. Atul Gawande, an Ivy League surgeon, wondered in the June 1 issue of The New Yorker magazine why McAllen, Texas, had one of the nation's highest levels of Medicare spending. Grand Junction's name came up in that article as one of the lowest spending regions.
Now, President Obama's team is using the Dartmouth study to leverage advancement of the Democrat party's health care proposal. Lastly, Dr. Michael Pramenko has hailed the virtues of our local health care in his recent column in the GJ Free Press in response to Dr. Gawande's article. Given the tremendous implications for all of us, I think this sequence is worthy of closer scrutiny.
The Dartmouth Atlas is being overstated. To briefly recap, the researchers collected data concerning Medicare spending during a person's last two years by looking backward after death. Expenditures were analyzed by hospital and geographical region. There was wide variation between individual hospitals and regions. Per capita hospital costs ranged from $13,706 (Dubuque, Iowa) to $51,917 (Manhattan, N.Y.).
Grand Junction came in at $14,739 while McAllen came in at $33,729. What the data did not provide was an explanation for these differences. The data also did not show whether these differences in spending had anything to do with the quality of the health care or any outcome other than death.
All the data showed is that some hospitals spent more than others. As such, this study could serve as a starting point for further research, not as a measure of how to model health care delivery for the nation as a whole. Now let me rephrase this in case you weren't paying attention. The death rate in this particular study was 100 percent. Yes, you read that right, every single patient analyzed in this study died! The only logical conclusion to be made is that Grand Junction is efficient at getting people to the point of death.
Hang on to your wallet, because the Dartmouth Atlas will now be touted as showing that some regions (Grand Junction being the shining example) are “more efficient” at delivering health care while saving money! This in turn will serve as the anvil upon which health care spending throughout the country will be hammered into line by a federally controlled health care system. In fact, the Dartmouth study reveals absolutely nothing about efficiency. Determining “efficiency” will require looking at end points other than death, and will include individual interpretations of value, quality and lifestyle. But those things are much more difficult to measure, so we are about to be treated to an example of using data wrongly to support a wrong-headed argument.
After listening to President Obama speak at ABC TV's recent health care forum, I was saddened to hear the leader of this country say the following when asked about a 100-year-old woman receiving a pacemaker.
“I don't think that we can make judgments based on peoples' spirit. That would be a pretty subjective decision to be making.”
Well, here's a little news flash for everyone. Doctors and patients make decisions every single day based on peoples' spirit, desires, values, individual preferences and all those other things that are so difficult to measure and regulate, but that define the human experience.
The current administration advocates a system that will take those difficult value judgments out of your hands and put them in the hands of a nice, caring, compassionate bureaucrat. If one could practice medicine by a cookbook approach, we would not need more family physicians, we would need fewer, because a simple computer program could do the job. But it just is not that simple.
President Obama went on to say: “I don't want bureaucracies making those decisions, but understand that those decisions are already being made in one way or another. If they're not being made under Medicare and Medicaid, they're being made by private insurers.”
He then added: “Maybe you're better off not having the surgery, but taking the painkiller.”
Health care services are finite, just like any other commodity. At its core, the entire health care debate boils down to distributing a finite number of dollars for the purchase of health care services for a diverse population of 300 million. The only way to do that is by allocating expenditures and resources, or in other words rationing.
Whether you know it or not, rationing takes place every day. Are you really getting full information about costs, benefits and options when you talk with your doctor? You might be surprised at what you are not being told. Is your doctor advocating for you, or for the insurance company? Are you being steered away from costlier options solely due to cost? The common thread between Dr. Pramenko's and President Obama's comments is that both are trying to reduce this complex problem into a simple financial equation. Once that happens, the dollar amount becomes the overriding concern. The (barely) unspoken message is that you have a duty to die cheaply in order to save money for everybody else.
Let me just add one parting thought. Any parlor magician hopes the audience is not really paying attention, so that the coin can be palmed undetected. I challenge others in this community to expose the sleight of hand. Now is not the time to be silent. I do not speak for everyone any more than Dr. Pramenko does. I would love to hear from others who are able to think independently. That is something the rest of the nation can emulate!
--------------------------------------------
Dr. Schroeder is a practicing pediatric cardiologist currently living and working in Grand Junction. He has previously practiced medicine in the military for 13 years and in San Antonio, Texas, for eight years. He attended Palisade High School. He attended college at West Point and the University of Colorado and medical school at Tulane University in New Orleans. Schroeder cares deeply about the future of his profession and the future his grandchildren will inherit.
