It’s no secret what the Dartmouth group’s solution for the health care system has been — reduce practice variation, get surgery and physician resource use rates similar to the Mayo Clinics’ of the world, and take the huge savings that would be generated to cover the uninsured. In fact Wennberg, Skinner, Fisher & Weinstein, now joined by “gone native” journalist Shannon Brownlee, have a new White Paper out—their own open letter to Obama’s mob.
Along the way that requires demand-side reductions (achieved by shared decision making) and supply side changes.
And there’s the rub. The Dartmouth gang logically point out that we
don’t need more doctors, and of course in their perfect world we
wouldn’t. But if we were to remake the world in (say) Mayo’s image,
we’d need a whole lot less of certain specialists and hospital spending
than we have now, and therefore a whole lot of specialists and
hospitals would be spending a whole lot of time telling Congress that
patients were going to be denied care.
Now, the Dartmouth gang have some chance of getting their message
across. As of Jan. 20, Peter Orszag will control White House bean
counting—and he’s a Dartmouth devotee. But realistically I can’t see
any of the logical policy initiatives that would flow from this
analysis coming as part of the new Obama/Daschle/Baucus initiative.
They’ll need too much help in Congress to get pay or play, the new
Medicare/Medicaid expansion, and the national connector up and running
(not to mention going after AHIP) to savage the doctors and hospitals
big time. And anyway, we don’t care about not spending money now—in
fact spending more money is good! (As Bush said, the government should
just go shopping!)
Of course (as regular commentator JD has been saying)
once if we’ve done the coverage thing, and once if there is one organization (e.g. an expanded Medicare) that controls much of overall spending, and once
if Congress starts caring about government spending levels again, then
the Dartmouth ideas will suddenly become relevant like the scribblings
of some defunct economist. Around 2015, my guess.