The Darmouth Atlas of Health Care, as readers may recall, has been a source of significant recent controversy, due to a skeptical front-page article published in the New York Times on June 3. Elliott Fisher and Jonathan Skinner of Dartmouth penned two rebuttals to the Times piece, in which they pointed out some of its factual and analytical errors. But the Dartmouth duo failed to address concerns about the key question underlying their research: is government capable of efficiently micromanaging medical practice?
Yesterday, Times reporters Reed Abelson and Gardiner Harris posted online a 3,000-word, 7-footnote response to the Dartmouth rebuttals. If anything, the reporters’ new piece is even harsher than their original one. It certainly makes for some interesting reading.
The Times reporters acknowledge that the Dartmouth researchers have conducted some cost-of-living adjustments in their academic research, but point out that such research is either absent from, or de-emphasized on, their public website:
The distinction between the atlas, as it is available on the Dartmouth Web site, and other published work by the Dartmouth researchers is important. In the academic sphere, the Dartmouth researchers often use careful statistical adjustments and nuanced language to qualify their findings. But on the Dartmouth Atlas Web site and in the halls of Congress where the atlas maps have become popular, there is little of that care, leading to conclusions and hospital and regional rankings that can present a misleading picture.Abelson and Harris go on to document evidence that, among other things: (1) Dartmouth’s Fisher exaggerated the strength of the Atlas’ findings in Congressional testimony; (2) other methodological problems exist with the Atlas; (3) the Dartmouth group has made wild claims about the amount of money government can save by adopting their recommendations.
For example, some prominent academics, despite their familiarity with the Dartmouth work, were unaware, until told by The Times, that the popular regional maps and hospital rankings published on the Dartmouth Atlas Web site were not adjusted to reflect the price and cost-of-living differences around the country.
That the Atlas has methodological problems is undeniable. That there is waste in the medical system is also undeniable. While I’ll be interested to see how the Dartmouth researchers and sympathetic bloggers respond to the latest salvo from the Times, I’m really hoping they’ll one day answer the important question: why will more government involvement lead to less waste?