Thursday, May 30, 2013

Sorry, your study is not PC . . . yet.

@JordanRau at @KHNews (Kaiser Health News) has correctly framed the public policy issue raised by a new report:

The idea that uneven Medicare health care spending around the country is due to wasteful practices and overtreatment—a concept that influenced the federal health law -- takes another hit in a study published Tuesday. The paper concludes that health differences around the country explain between 75 percent and 85 percent of the cost variations

“People really are sicker in some parts of the country,” said Dr. Patrick Romano, one of the authors.

That’s a sour assessment for those hoping to wring large savings out of the health care system by making it more efficient. Some, such as President Barack Obama’s former budget director, Peter Orszag, assert that geographic variations in spending could mean that nearly a third of Medicare spending may be unnecessary.

I hold no brief for this study, or for the previous ones by the folks at Dartmouth.  What I view as interesting is the manner in which public policy in the health care arena is or is not whipsawed by the latest study.  What would happen now if a major part of the framework for ACOs, risk-based contracting, and increased concentration of the health care industry is viewed as up for grabs?

Here's what I predict.  That re-evaluation will not happen, at least right away.  The new report will be viewed as politically incorrect, disagreeably contradicting the current views of many parties who now have a vested interest in the new direction of the national health care system.  It's methodology will be critiqued by those benefiting from the new status quo--just as the Dartmouth report was critiqued for many years with those benefiting from the old status quo.  Then, the conclusions will take hold, and policy will shift again.

It takes a while for a pendulum to reach its high point and for momentum to shift, but gravity is not just a good idea:  It's the law.

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