The New York Times changes the Dartmouth Atlas narrative

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat.

In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients.  Their main, take home message is that high-spending areas of the country sometimes had poorer outcomes than lower-spending ones.

Their work has been influential with the current administration, and among progressive health reformers.  Last week however, the New York Times published a front page story critical of their conclusions.

Predictably, left-leaning bloggers, like Matthew Holt, Jonathan Cohn, Kevin Drum, and Maggie Mahar, were critical of the Times’ piece.  Mr. Holt, for instance, called it a “dreadful article.”

I’m not a policy maven, so I’m not going to comment on the specifics.  Read the Times’ piece, then the Dartmouth rebuttal, and come to your own conclusions.

I will, however, comment on how this affects the overall narrative — which is what’s important in the end. Face it, most of the public aren’t astute health policy analysts, rendering the point-counterpoint debate between the Times and Dartmouth largely inconsequential to most people.

But progressive commentator Kevin Drum made a comment that caught my eye:

By the time their piece is done, they’ve basically only got two things left. First, the Dartmouth researchers admit that, on occasion, they might discuss their findings more broadly than they should when they’re talking to a lay audience. Second, there are individual bits and pieces of their dataset that other researchers have disputed. Just as there are with any large, complex dataset.

I actually think the first point cannot be dismissed.  Narrative matters to the lay audience. And when the current administration is clearly influenced by Dartmouth, conclusions that are overstated cannot be ignored:

In interviews, Dr. Fisher and Mr. Skinner acknowledged that there was no proven link between greater spending and worse health outcomes. And Dr. Fisher acknowledged the apparent inconsistency between his statements in interviews with The New York Times and those made elsewhere, saying that he was sometimes less careful in discussing his team’s research than he should be.

More expensive care may not be better — but the emerging narrative that “cheaper care is better,” is certainly not always the case.

To be clear, I’ve always supported the Dartmouth work, and find their efforts instrumental in trying to convince patients that more medicine isn’t always in the patient’s best interests.

But we can’t base health policy on the faulty notion that “cheaper medicine is better” either.

The Times, if anything, re-directed the Dartmouth narrative to a more realistic trajectory. And I don’t see how that’s a bad thing.

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