Wednesday, the New York Times once again launched an attack on what has become known as “the Dartmouth research.” As regular HealthBeat readers know, more than two decades of studies done by medical researchers at Dartmouth suggest that hospitals that provide the most expensive care often are over-treating their patients, squandering billions of healthcare dollars, while exposing patients to unnecessary risks.

For some of Manhattan’s priciest hospitals this is a sensitive subject. As the Times notes: “Some proposals in Congress call for using the analyses . . . to begin spending less money on regions where medical care is especially costly, including places like New York City.”

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Do the uninsured die sooner than the rest of us becaue they don’t have access to medical care—or because more than three-quarters of the uninsured are poor?  In part 1 of this post, I explained that we know that poverty is a killer. It destroys mind and body, slowly but surely. In the U.S. the poor die seven years earlier than the rich.

I also explained that lack of access to medical care is not a major factor in determining who dies prematurely. Social circumstances, personal behaviors, and environment account for 60% of early deaths, and each is closely tied to socio-economic status.

Most Americans assume that good health care is the key to longevity. But in 2002 the Kaiser Family Foundation published a study that poses a radical question, “Does having health insurance improve your health?“ It might sound like a foolish query. One wants to say “Of course!”

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If we had universal coverage, how many lives would be saved?  This is the issue that the Atlantic’s Megan McArdle and the Washington Post’s Ezra Klein were debating last week. The controversy caught my eye because I’ve long been skeptical about claims that tens of thousands of Americans die each year because they don’t have access to health care.

 I know we all like to think of medical care as “life-saving.”  If we just detect disease early enough, and find the right doctors, they will cure whatever ails us. But I would argue that the primary purpose of medicine is not to prevent death. If it were, one would have to judge the entire enterprise an abysmal failure.  No one beats death. Granted, some die sooner, others later. Yet as I will explain, health care is not the major factor that leads to longevity.

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While others seem ready to declare health care reform dead, Henry Aaron explains why reformers must stay the course in the most recent issue of the New England Journal of Medicine. They have everything to lose, and nothing to gain if they abdicate their responsibilities now. More importantly the nation will be left with a health care system that fails society while threatening our economy.
 
While others flail about, the Brookings Institution Senior Fellow makes his case in calm, lucid prose, reminding us that nothing has changed over the past month. The House and Senate have, in fact, managed to pass two very similar bills. If you explain the legislation to the public, the majority of Americans favor reform. All that remains to be done is to reconcile those bills—which in the end requires a simple majority.

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For more information on the film, produced by Alex Gibney, directed by Andrew Fredericks,  and based on the book by Maggie Mahar, see www.moneydrivenmedicine.org
These are free public showings. I’ll be doing a Q&A with the audience following each screening and look forward to meeting HeatlhBeat readers in the area.

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Thursday February 18
The South County Partnership of Fremont, California is sponsoring a screening at the Crown Plaza Union City, Alvarado-Niles Road Union City, CA 
 Refreshments: 4:30 to 5 p.m. Program: 5 to 7 p.m.
To RSVP or for more information, email: southcountypartnershippresents@gmail.com

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Friday, February 19th
Berkeley University will be showing the film at the University Hall Room, 150 on the Berkeley Campus, 4:30 pm- 7 p.m.

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Tuesday, March 10 
The Drexel School of Public Health is sponsoring a screening at  the  Drexel University School of Public Health, Mitchell Auditorium, Bossone Research Center, 32nd and Market Streets, Philadelphia, PA

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Sunday, March 13
National Physicians’ Alliance Conference
Long Beach, California
Details to follow

Massachusetts has succeeded in providing health care insurance for all but 2.6% of its citizens. Yet the Commonwealth still struggles to make that coverage affordable. Health care inflation is driving Massachusetts’ system toward a cliff.  Total outlays for medical services and products are climbing 8 percent faster than the state’s economy.  Unless something is done to rein in the cost of care, health care spending in Massachusetts is projected to nearly double over the next 10 years, hitting $123 billion in 2020. State officials know they must find a way to put a lid on spending so that it grows no faster than the state’s gross domestic product.  .

But how?

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Someone sent me a link to this post written by Chris Dunn on “Words and Light.” It is titled: “I’m Furious,” and it begins: “I’m furious because I have to read this book:

“Money-Driven Medicine” by Maggie Mahar

Photo by Chris Dunn

“I’m in my final undergraduate semester, and only now am I taking my first-ever political science course. The class is Public Policy, and for our first paper, we are to read this entire book and write a book review.

“That’s not (exactly) why I’m furious.

“I’m furious because I’m learning, in detail, about the failures of the American health care system according to one author-journalist.

“I’m furious because I procrastinated in starting this book, which has prevented me from going out and making pictures and blogging a real photo for my first entry in this 30-day series.

“I’m furious because, although I’m far more interested in being a photographer than in being a student, my academics and work schedule this semester are severely limiting the time and opportunities I could have to pursue better photography.”

Somehow, this post made me smile.

I wrote to Chris (who is a senior at the University of Missouri, where she majors in journalism, photo-journalism and photography) to say “I’m sorry” the book is so long.

But U.S. health care is a complicated topic, and I wanted to include both facts and stories.  (Numbers alone are too boring. Anecdotes alone are not persuasive.)

I also told her that it’s a nice photo of the book—which it is. And the photo on the top of her home page is outstanding. (My husband, who is a photographer, admired it.)

While health care reformers argue about what it would take to “break the curve” of health care inflation, the state of Maryland has done it, at least when it comes to hospital spending.

In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission.

When setting rates, the Commission takes into account differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients. For example, the Commission sets the price of an overnight stay at St. Joseph Medical Center in suburban Towson  at $984,  while letting  Johns Hopkins, in Baltimore Maryland, charge  $1,555. For a basic chest X-ray, St. Joseph's asks  $81 and Hopkins' is allowd to  charge  $155. The differences reflect Hopkins's higher costs as a teaching hospital and the fact that it cares for generally sicker patients.

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Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?

On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. And yesterday, the British medical journal Lancet finally retracted the resulting 1998 study authored by Wakefield that helped drive MMR vaccination rates in the U.K. down to the point where in 2008, measles was officially declared “endemic” in the country.

The Lancet’s editor, Richard Horton, told The Guardian "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false," he said. "I feel I was deceived."

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Health reform may be stalled in Congress, but you need only look to the overburdened Medicaid program to find evidence of the continued toll the current economic crisis is taking on Americans’ ability to afford and access medical care.

At the same time that states are experiencing huge budget deficits, more and more of their residents are unemployed; more and more are joining the ranks of the uninsured and clamoring for Medicaid benefits. The result: Even with emergency federal infusions of funding, state safety nets are being stretched dangerously thin.

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