So says RAND:
The new U.S. health care reform law was the best option for providing health insurance to the largest number of people while keeping federal government costs as low as possible, according to an analysis by the RAND Corp., a nonprofit policy think tank.
Researchers used a specially designed computer model to simulate more than 2,000 different policy scenarios and found that the only alternatives to the new health reform law were all politically difficult because they would have included much higher penalties for noncompliance, lower government subsides, and less generous Medicaid expansion.
The study is in the June issue (Moving Forward on Health Reform)of Health Affairs.
From the same journal is an interesting article entitled Evidence That Consumers Are Skeptical About Evidence-Based Health Care:
We undertook focus groups, interviews, and an online survey with health care consumers as part of a recent project to assist purchasers in communicating more effectively about health care evidence and quality. Most of the consumers were ages 18–64; had health insurance through a current employer; and had taken part in making decisions about health insurance coverage for themselves, their spouse, or someone else. We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as "medical evidence" or "quality guidelines." Most believed that more care meant higher-quality, better care. The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making.
This has major implications moving forward. The botched release of mammogram guidelines is another example to consider (see On Cancer Screening, Politics, and Communication.)
Finally, our own DrSteveB reviews the contrast between underserved and overtreated:
The short answer is that is it true that, even after accounting for actual higher need (e.g., more sick local population and more sick individuals) and quality of care, there is still excess cost in some areas. And this cost is partly due to unneeded care, inapropriate care, wrong care, poor care, excess care, local "professional cultural" practices not grounded in evidenced based care, unwarranted care (excess volume), unwarranted higher costs (excess unit-cost), etc. The bottom line is that there really is unwarranted and substantial variation in the cost of care for people of similar health depending where they happen to live and which institutions they go to. It is also the case that clinicians and institutions with the best results can have lower (e.g., Mayo Clinic), not higher, costs than average.
It should also be noted that there are legitimate critiques about the degree of controlling for quality, the degree of controlling for case-mix (amount and severity of illness), whether local cost of living ought to be factored in, the legitimate role of the higher cost of teaching (medical students, residents, fellows) and research institutions. But in their essentials, the Dartmouth research is valid and important.
However, there is also a progressive critique of the "over-treated" argument, partly due to the actual Dartmouth research focus, but especially due to some of the uses others (not the Dartmouth researchers themselves, for the most part) have put it to.
Health reform was always going to be difficult, and passage of the new health care bill won't change that. Keeping an eye on what's happening down the road will be a continuing feature here, shared by many of the front pagers. Consider this your latest update.