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<DIV style="FONT: 10pt arial">----- Original Message -----
<DIV style="BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A
title=tanstl@aol.com href="mailto:tanstl@aol.com">David Sladky</A> </DIV>
<DIV><B>To:</B> <A title=undisclosed-recipients:
href="mailto:undisclosed-recipients:">undisclosed-recipients:</A> </DIV>
<DIV><B>Sent:</B> Saturday, June 05, 2010 10:17 AM</DIV>
<DIV><B>Subject:</B> Fraudulent study used to sell Obama health plan</DIV></DIV>
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<H4>The New York Times and the Dartmouth Atlas study</H4>
<H2>Fraudulent study used to sell Obama health plan</H2>
<H5>By Patrick Martin <BR>4 June 2010</H5>An article published in the <EM>New
York Times</EM> Thursday notes the rising volume of criticism by health care
professionals of the Dartmouth Atlas of Health Care, a study purporting to show
that much of the health care service provided by US hospitals is misguided and
unnecessary and that major cuts can be made in health care costs without
impairing patient care.<BR>The study was touted by the Obama administration as
part of its campaign to pass its health care reform legislation, with budget
director Peter Orzag citing the study repeatedly to support his claim that up to
$700 billion in annual US health care spending is “waste” that could be
eliminated without hurting patients.<BR>The <EM>World Socialist Web Site</EM>
has written on the fundamentally fraudulent methodology of the Dartmouth study,
which is limited to Medicare patients during the final six months or two years
of their lives thus excluding positive outcomes for treatment that extends life
for a longer period, and which ignores regional variations in patient illnesses,
hospital wage rates and similar costs. (See “<A
href="http://wsws.org/articles/2010/mar2010/dart-m02.shtml" target=_blank>The
Dartmouth Atlas of Health Care study: Shoddy science in support of health care
cuts</A>”) The WSWS also interviewed prominent medical critics of the Dartmouth
approach, including <A
href="http://wsws.org/articles/2010/mar2010/coop-m02.shtml" target=_blank>Dr.
Richard Cooper</A> and <A
href="http://wsws.org/articles/2010/mar2010/ong2-m02.shtml" target=_blank>Dr.
Michael Ong</A>.<BR>The Dartmouth Atlas measures the cost of care delivered to
Medicare patients, which varies widely across the regions of the country. In the
maps contained in the Atlas, low-cost regions are in beige, high-cost regions in
brown. As the <EM>Times</EM> article, written by Reed Abelson and Gardiner
Harris, notes: “Measures of the quality of care are not part of the formula. For
all anyone knows, patients could be dying in far greater numbers in hospitals in
the beige regions than hospitals in the brown ones, and Dartmouth’s maps would
not pick up that. As any shopper knows, cheaper does not always mean
better.”<BR>The article continues: “The mistaken belief that the Dartmouth
research proves that cheaper care is better care is widespread—and has been fed
in part by the Dartmouth researchers themselves.”<BR>The essential charlatanry
of the approach is spelled out—though not stated that explicitly—in another
passage: “But the atlas’s hospital rankings do not take into account care that
prolongs or improves lives. If one hospital spends a lot on five patients and
manages to keep four of them alive, while another spends less on each but all
five die, the hospital that saved patients could rank lower because Dartmouth
compares only costs before death.<BR>The <EM>Times</EM> article later concludes,
“there is little evidence to support the widely held view, shaped by the
Dartmouth researchers, that the nation’s best hospitals tend to be among the
least expensive.”<BR>More may be involved than bad research methods or political
bias. Some of the Dartmouth researchers apparently had a direct financial
incentive to find the kind of results they published. The <EM>Times</EM> article
reports:<BR>“In any case, the more-is-worse message has resonated with insurers,
whose foundations now help to finance the Dartmouth Atlas. Dartmouth researchers
also created a company, Health Dialog, to consult for insurers and others on
Dartmouth’s findings. Valued at nearly $800 million, the company was sold to a
British insurer in 2007 and still helps to finance the Dartmouth work.”<BR>Only
one thing is lacking in this debunking of the Dartmouth Atlas—a single word
about the role played by the <EM>New York Times</EM> itself, both in its news
pages and editorially, in promoting the Dartmouth study as part of its year-long
effort to present the Obama health care program as a progressive social reform,
and disguise its essentially reactionary character as an exercise in
cost-cutting and medical rationing.<BR>The Dartmouth study was cited at least 11
times in major articles published in the <EM>Times</EM> in 2009, including three
by Reed Abelson, the co-author of the latest article. For the most part, these
articles accepted uncritically the authority of the Dartmouth Atlas.<BR>On
August 12, 2009, the newspaper published an op-ed column broadly endorsing the
Obama administration’s efforts “to change how care is delivered so that it is
both less expensive and more effective.” It was signed by four doctors: Elliott
Fisher, co-director of the Dartmouth study; Donald Berwick, recently nominated
by Obama to head the Centers of Medicare and Medicaid; Mark McClellan, who
headed CMM in the Bush administration; and Atul Gawande, whose long June 1
article in the <EM>New Yorker</EM> last year was frequently cited by the
administration as proof that health costs could be cut radically without
impairing patient care.<BR>On November 8, 2009, the <EM>New York Times
Magazine</EM> published a cover story by David Leonhardt, one of the newspaper’s
main writers and commentators on economic questions, promoting the Dartmouth
study, under the headline “<A
href="http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html"
target=_blank>Making Health Care Better</A>.” Leonhardt wrote to celebrate the
quality of the low-cost medical care provided by Intermountain Health Care, a
chain of hospitals in Utah and Idaho singled out for praise in the Dartmouth
study—which was itself repeatedly cited in the article.<BR>The <EM>Times</EM>
editors themselves applauded the Dartmouth study. In its June 14, 2009
editorial, “Doctors and the Cost of Care,” the <EM>Times</EM> claimed that
“profligate physician behavior” was at the root of rising health care costs, and
the editors cited “pioneering studies by researchers at Dartmouth into the
reasons for large regional and institutional variations in Medicare
costs.”<BR>The editorial continued, “After adjusting for differences in health,
income, medical price and other factors, the Dartmouth researchers’ overall
conclusion is that the more costly areas and institutions provide a lot more
tests, services and intensive hospital-based care than the lower cost centers.
Yet their patients fare no better and often fare worse because they suffer from
the over-treatment. The Dartmouth group estimates that up to 30 percent of
Medicare spending is wasted on needless care.”<BR>The editorial concluded that
“most experts think the Dartmouth research is essentially right,” and called on
President Obama to enlist doctors into his campaign to cut health care
costs.<BR>Now the newspaper has been compelled to admit that “most experts” do
not think the Dartmouth research is “essentially right,” but the damage has been
done. The Obama administration used the study as one of its ideological weapons
to conceal the reactionary character of its cost-cutting program, which was
given final approval by Congress and signed into law in March.<BR>The admission
by the <EM>Times</EM>, after the fact, that one of its principal arguments for
the Obama plan was based on bad, and perhaps deliberately bad, research, does
not in any way cause the editors to reconsider their attitude to the health care
program. On the contrary, the explosion of the claim that there are hundreds of
billions of dollars in “waste” that can be easily cut to finance the health care
program will lead both the Obama administration and its liberal apologists to
demand harsher and more obviously painful cuts in spending, which will
ultimately deprive millions of working people of access to needed health care
services.<BR><BR>
<HR>
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target=_blank>Get busy.</A> = </DIV><!-- end of AOLMsgPart_2_204da0d2-c569-4dee-8f57-b42415c580c2 -->
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