Most discussions of regional variations in healthcare focus on the nation’s cities. Below, a first-of-its-kind map from a post on the Daily Yonder titled “The Uneven Cost of Rural Health Care.”

Daily Yonder/Dartmouth Health Atlas

This
map shows the difference in per capita Medicare costs among 1,845 rural
hospital service areas. Green areas have costs below the national
average. Brown areas are above the national average. For a larger
version of the map, click here.

The map and the post are based on data collected by researchers at the Dartmouth Medical School. Doctors and economists there take a sample of Medicare costs from some 1,843  hospital service areas where a majority of the  people are  living in rural or exurban zip codes.

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I appeared on Lou Dobbs last night, debating Douglas Holtz-Eakin, a former director of the Congressional Budget Office, and a fellow at the Manhattan Institute. You’ll find the video here.  It actually turned out to be fun. (My children tell me that the segment was very funny. Then again, they are my children.)

Here I would like to expand on just one point that came up at the beginning of the show regarding the so-called “doctor’s fix.” Yesterday and today, newspapers have been filled with the news: in an effort to assure that physicians support health care reform, they claim that Democrats have promised to nix a plan to cut the fees that Medicare pays doctors by 21%. The cuts were scheduled for this January.  Over a ten-year period this “doctor’s fix” will cost $247 billion, the opponents of healthcare reform charge.

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They are running scared.

And why are they so scared?

Because they know that the public sector option is still alive. And here I’m not talking about the possibility that some states will offer public plans: Most state plans would be too puny to challenge the strongmen of the health care industry. I’m talking about  a federal public plan–Medicare E (Medicare for everyone) a public option for patients under 65,  run by the federal government.  The scent of real competition is what has insurers on the run.

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As long-time HealthBeat readers know, I have some reservations about hospitals plunging huge sums into plush hotel-like amenities—spas, gourmet food, marble lobbies, mahogany-paneled doctors’ lounges  . . ..  See “Who Will Pay for the Waterfalls?”

I tend to think that hospitals should plow any extra money into programs that will protect patients: infection control, electronic medical records that would prevent medication mix-ups, and so on.

But patients can’t see these improvements. And in competitive urban and suburban markets (where, typically, too many hospitals are vying for well-insured patients) hospital CEOs know that the cosmetic improvements appeal to upscale, well-insured patients.

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Money-Driven Medicine, the film produced by Academy-Award winning filmmaker, Alex Gibney (Taxi to the Dark Side; Enron: The Smartest Guys in the Room), directed by Andy Fredericks, and based on my book (Money-Driven Medicine: The Real Reason Health Care Costs So Much) , will be screened at the U.S. Capitol in Washington DC on October 27.

Alex Gibney and I will be doing a Q&A after the screening, moderated by the Washington Post’s Ceci Connolly.

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Below, a guest-post by Nortin M. Hadler, M.D., Professor of Medicine and Microbiology/Immunology at UNC Chapel Hill’s School of Medicine.Dr. Hadler is also an Attending Rheumatologist at UNC Hospitals, and author of The Last Well Person: How to stay well despite the health care system,  Worried Sick, A prescription for health in an overtreated America and Stabbed in the Back, Confronting back pain in an overtreated society.

I don’t buy lottery tickets. True, someone will win, and likely a mind boggling windfall. That someone may be one in a million, but someone will win. It is so unlikely to be that someone, maybe there’s a magical force at play, maybe a gambler’s gryphon or a good fairy. Many reasonable Americans must believe in the gambler’s gryphon. Some have premonitions, a sense that the gryphon will fend for them in the deepest reaches of improbability where the power ball hides. None of this is irrational behavior. All understand the probabilities and many get a kick out of the possibilities.

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The Mayo Clinic now has two family medicine clinics in Arizona. Beginning January 1, primary physicians at one of those clinics will no longer see Medicare patients unless they are able and willing to pay an annual $250 administrative fee, plus $175 to $400 per visit . They will also have to agree to“an appropriate number of visits each year, including physicals.

 The total annual costs for the physical and three office visits would be about $1500, according to  the letter that Mayo sent  to the 3,000 patients who receive care at the clinic. The letter also informs those patients that they will not be able to transfer their primary care to another Mayo facility.

Michael Yardley, chairman of public affairs of the Mayo Clinic in Arizona, said the changes are necessary because Medicare’s reimbursement rates for primary care are so low.  "It has been difficult for us to be able to sustain our own medical practice in a way to provide the best care to patients and for us," he told a local news outlet, youwestvalley.com.  “For some the $1500 annual fee- will be cost-prohibitive, and that’s why it’s so painful," Yardley acknowledged. "We have a list of physicians for them that are accepting new Medicare patients. We have done homework in that area, and we have customer service representatives for folks who we are encouraging them to talk to about it."

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There is now some talk of finding a compromise to the public option debate by including the public option in health reform legislation—and then letting individual states “opt out” leaving their citizens without the opportunity to sign up for a less expensive public plan modeled on Medicare, and letting private insurers set the market rules in those states. 

(Not long ago, the Washington Post reported that private insurers are already figuring out ways to “shun the sick,” despite health care reform. While they won’t be able to deny care because of pre-existing conditions, they can make their plans less attractive to cancer patients by including fewer oncologists in their networks.)

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Below, a guest-post by HealthBeat reader Frederick L. Moolten, M.D. Professor of Medicine at the University of Pittsburgh Medical Center, he has devoted several decades of his career to cancer research, supported by the NIH and the VA.

We love wars.  Ever since our nation was forged in the heat of the American Revolution, we have celebrated victories in some (World War II – the “good war”), lamented the agony of others (the Civil War), and debated the merits of more recent ones, including Iraq and now Afghanistan.  Our combativeness extends into the realm of metaphor—hence the War On Drugs, the War On Poverty, and the War On Terror (only part metaphorical).  None of these has yet outlasted the War On Cancer, which we have been fighting for more than a century. Why have we not yet won?

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Over at the Hasting Center’s new “Values and Health Reform Connection,” blog Joanne Kenen’s candid post, “Honest Debate, and Candid Solutions” caught my eye. I recommend it to HealthBeat readers.  (Kenen writes The  New America Foundation’s “New Health Dialogue Blog.") Below, an excerpt:

“Liberty. Justice, Responsibility, Solidarity.

“These are some of the American Values highlighted in the Hastings Center’s report on Connecting American Values with Health Reform.

“Watching health reform unfold here in Washington, however, that ‘Connection’ is painfully elusive.  The debate is not a careful calibration of competing rights, values and obligations. It’s a political moshpit. Instead of values, we have vitriol.

“Outside of Washington, even extremely astute people ask me why we can’t fix a health care system that is inefficient, inequitable and downright inexplicable.

“I patiently explain that this fight is not purely about policy (or values). Health policy becomes a gritty proxy for politics.

“Values, or at least ideology – particularly about the size and reach of government – play a role in politics. But an awful lot of what passes for policy debate is trench warfare before the next election.  Look at the list of amendments proposed for any of the major bills – and ask yourself how many are meant to improve the health and well-being of the American people and the American economy, and how many are meant to score points, woo donors, placate interest groups and create a C-Span moment.” [my emphasis]

To read the rest of Kenen’s essay, click here.