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AMA Study Undercuts Key rationale for ObamaCare

by | Mar 30, 2012

By Jennifer Popik, JD, Robert Powell Center for Medical Ethics

Jennifer Popik, J.D. Robert Powell Center for Medical Ethics

 This week’s oral arguments in the U.S. Supreme Court over the constitutionality of the  Obama Health Care law (ObamaCare) centered on the law’s individual mandate that every American buy health insurance and the mandates for Medicaid spending it imposes on the states.  The merits of these constitutional issues concern pro-life advocates only to the extent that the Court’s ultimate ruling on them may determine whether the most pernicious components of the massive health care law, including provisions to ration lifesaving care and to greatly expand federal subsidized abortion insurance, are ultimately imposed on the United States.

One of the Obama Health Care Law’s key concepts is government-imposed limits on what Americans are permitted to spend on health care.  The law requires an “Independent Payment Advisory Board” to devise means of preventing that spending from keeping up with medical inflation. The federal Department of Health and Human Services is empowered to enforce  these means by imposing so-called “quality” and “efficiency” standards on health care providers that would limit the treatment they are permitted to give to their patients so that the spending ceiling is not exceeded.

The surprising assertion by some Obama Health Care Law supporters that such limits would not amount to rationing life-preserving medical treatment rests on the claim that greater efficiencies in health care delivery can result in producing the same level of health care with fewer resources.  However, this claim faces a fresh round of criticism.  This notion that we can spend less on health care does with no effect on healthcare outcomes is at odds with a Journal of the American Medical Association study published in the March 12, 2012 edition.

An article from Canadian researchers titled “Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals,” documents that patients treated at higher-spending hospitals in Canada saw better overall outcomes. 

The authors wrote, “We found that higher hospital spending intensity was associated with better survival, lower readmission rates, and better quality of care for seriously ill, hospitalized patients in Ontario in a universal health care system with more selective access to medical technology.”

This conclusion would seem to contradict the view of the often cited Dartmouth Atlas College research project, which maintains that American hospitals that spend more per patient do not get better results. (The compiled research focused on the spending levels of Medicare patients with a chronic illness who were in their last six months or two years of life.)

In its push to enact the Obama health care law, the Obama administration frequently made the argument that it would pay for the law by simply cutting billions in wasteful health care spending, and that there would be no negative effect on the quality of care people receive. Throughout the course of Congressional health care hearings leading up to the health “reform” passage, as well as in open floor debates, ObamaCare advocates would over and over cite to the Dartmouth Atlas, often inviting its authors to testify. Advocates touted the research as if it was definitive proof of their claim.

The Dartmouth research makes the claim that the U.S.  could cut billions of what it characterized as “wasteful” spending and actually make people healthier. The New York Times quotes Dr. Elliott Fisher, a physician who is one of the principal authors of the Dartmouth work, writing, “We show where the waste is in medicine. If everyone could operate like Oregon, Seattle or the Upper Midwest, there’s huge savings.”

In a 2010 article, the New York Times provided a systematic review of varying criticisms titled, “Study Cited for Health-Cost Cuts Overstated Its Upside, Critics Say.”  They pointed to a key criticism of the compiled research writing,

“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. ‘It may be that some places that are spending more are actually getting better results,’ said Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale. Failing to receive credit for better care enrages some hospital administrators.”

In short, despite the criticism, the mentality that believes we could get better care by spending less in the U.S. filled every corner of the Obama Health Care Law.

The Canadian study cited above looked at four specific conditions: heart attacks, heart failure, hip fractures, and colon cancer, finding that in treating them with the more advanced and intense care (and yes- costlier care) yielded better survival rates.  The authors went to great lengths to correct for the criticisms levied at the Dartmouth study writing, “Because sicker patients use more services, higher-spending hospitals may appear to have worse outcomes, in part because patients are more severely ill. We used several techniques to remove this potential ‘reverse causality,’ as in previous work.”

While more aggressive spending yields better outcomes, how can people afford to pay for it?

NRLC has long argued that the increasing spending on health care does not require rationing life-saving treatment. ObamaCare advocates wanted to sell the idea that by simply cutting wasteful spending, the expansion could pay for itself. This faulty and gratuitously cited Dartmouth Atlas compiled research gave them cover for that argument – cover that is quickly evaporating.

However, when increased health care spending does in fact save lives and increase quality, the Obama health care law offered no real long-term way to pay for the kind of quality care Americans deserve.

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Categories: ObamaCare