Peter Orszag, a former White House budget director and an Obamacare supporter, ignores this evidence and tries to reassure seniors that Medicare spending could be cut by 30 percent without harming seniors. He cites the Dartmouth Atlas of Health Care 2008, which tries to prove that patients who get less care — fewer hospital days, doctors’ visits, and imaging tests — have the same medical “outcomes” as patients who get more care. But read the fine print. The Dartmouth authors arrived at their dubious conclusion by studying the records of patients who had already died. Of course the patients treated at the high-spending hospitals and the low-spending hospitals had the same end result. They were all dead!
Fortunately, researchers have set the record straight. Data published in the Archives of Internal Medicine show that seniors treated in hospitals providing more intense care and greater spending have a better chance of recovering, going home, and resuming their lives. Seniors treated at the lowest-spending hospitals die needlessly. Researchers found that 13,815 California seniors treated at low-spending hospitals would have survived and left the hospital had they received the extra care provided at higher-spending hospitals. Reducing care at the very end of life may be wise, but these across-the-board Medicare cuts will result in reduced care for all patients, including those who could survive their illnesses and go home if they get the care they need.
New Medicare Efficiency Measures
In addition to the across-the-board cuts in payments to hospitals, Section 3000 of the Obama health law actually awards bonus points to the hospitals that spend the least per elderly patient. The bonus system went into effect on October 1, 2012. Hospitals that spend the least “per Medicare beneficiary” get rewarded, and hospitals that spend more get whacked with demerits. This despite the evidence that patients have a better chance of surviving at higher-spending hospitals. Hospitals will even be penalized for care consumed up to thirty days after patients are discharged — for example, for outpatient physical therapy following a hip or knee replacement.
Dr. Betsy McCaughey is the author of Beating Obamacare: Your Handbook for Surviving the New Health Care Law.