The Latest Game in Washington is to Beat Up on Doctors - Posted 6.15.09

On June 1, The New Yorker published a piece by Dr. Atul Gawande examining the driving forces behind a Texas town's high per-capita Medicare spending. The piece concluded it's "the across-the-board overuse of medicine." The article says physicians' profit motives seem to be fueling the overutilization but concedes the differences in the number of doctor-ordered tests and procedures could simply be attributed to different medical training.

Next, The New York Times and The Washington Post spun stories off The New Yorker's premise, that regional differences in Medicare spending indicate huge waste and overutilization that could be cut out of the system and save the government immense money as part of health care reform. The Times' Robert Pear took a balanced approach, while the Post's Ceci Connolly bought the argument hook, line and sinker. Finally, Post columnist Steven Pearlstein wrote yesterday that the central question of reform is how to get doctors to more uniformly use medicine's best practices.

The Obama Administration is treating the New Yorker piece as gospel - the president himself reportedly handed it out to senators - despite the speculative leaps the author took to reach his conclusions. None of the stories spent significant time examining the role of diverse patient demographics or other causative factors in Medicare cost disparities.

CMA monitors most California newspapers - you should all now be receiving our daily "In The News" digest - but we ask you to help us by keeping an eye out for stories on these issues in your local paper. If you see stories along these lines, here are some ways to respond through Letters to the Editor or online comments.

Key points include:

1. Many factors and many players contribute to regional differences in Medicare spending, not just doctors, and it is driven by much more than just overutilization.

a. Populations differ vastly region to region; ethnicity, the diversity of cultures, the number of languages, economic circumstances and age all differ from region to region and can play a role in an individual's health and how he or she is treated.

b. Regions also differ in the type of living environments they provide, the availability of technology and the core missions of hospitals there, including whether some are teaching hospitals that are working to innovate and pioneer new treatments.

c. Doctors are not solely responsible for determining a patient's treatment. The treatment pursued is heavily influenced by the patient's own wishes, hospitals and insurers.

2. To counter overutilization, California doctors favor health care reform that focuses on primary care and prevention. The goal of reform should be to put patients first and make sure they have access to doctors when they need it.

a. Doctors support any number of approaches that would improve coordination of care and avoid duplicative tests or treatments.

b. The Obama administration has already funded comparative effectiveness research, and as doctors, we welcome more independent research on what medical treatments are the most effective.

Please let me know if you have any questions or would like further assistance.

California Medical Association