A couple of weeks back two New York Times reporters (Abelson & Harris) decided to take on the orthodoxy of the Dartmouth school. Frankly their efforts reminded me of England’s performance in the world cup so far—abject and inept and leaving the fans hoping for much better. Within a few hours the mainstays of Dartmouth (Fisher & Skinner) responded correctly accusing Gardiner and Harris of shaky reporting. Although that original article was particularly muddled, there are indeed legitimate questions about some of the Dartmouth research, raised by serious academics (including on the august pages of THCB), but few of those made their way into the hodgepodge that was that original article. And now in their response to the response, Abelson & Harris have descended further into the mire.
The new argument is basically this. Yes, the Dartmouth academics have done all the corrections to regional data that the NYTimes duo accuse them of not having done. But they’re not available on the website within a click, not always portrayed in the maps in the Atlas, and (horror of horrors) you’d have to read Health Affairs to find out what they’d done. And that some of the academics who read Health Affairs hadn’t carefully looked at the maps which showed unadjusted data.
So now it’s not an academic issue or a misstatement. It’s an issue of poor user interface design! Well I guess we’re used to that in health care!
But let’s not have the Dartmouth researchers respond. There’s no need because the response comes inadvertently in the New York Times this very same weekend. Abelson & Harris in their article ask the key question, “Does higher medical spending lead to worse care?” Precisely, the Dartmouth gang say unproven, but they clearly believe it to be the case. And Harris & Abelson try to hang them with that distinction.
But the punishment that should be meted out to Harris & Abelson is to read a wonderful article by guest author Katy Butler in the Sunday NYT Magazine. It’s titled What Broke My Father’s Heart. Please read it fully.
It’s a fabulous article about the real life over-treatment of the author’s father, and the havoc and devastation that caused on the author’s family—especially her wonderful mother. And it’s an inadvertent and fabulous answer to Harris & Abelson’s question.
Yes, more care, incented by the system and profitable to far too many actors within it, is worse care.
Categories: Matthew Holt