A front-page New York Times story last week on the Dartmouth Atlas Project caused immediate controversy among many left-leaning blogs. Now, a few conservatives and libertarians have also weighed in on the debate.
John Goodman compares the debate to that over public education, and says:
I think the work of Elliott Fisher and Jonathan Skinner is very important. But behind the very public to and fro about their work is a very important policy issue that all sides allude to and none are confronting directly. To wit: Can we (meaning the government) use statistics on Medicare spending to force the health care system in general, and Medicare providers in particular, to deliver more efficient, higher-quality care?
The weight of the evidence I believe is fairly clear: No, we cannot. …
In general, a bureaucratic system is one in which normal market forces have been systematically suppressed. In such an environment, there tends to be a sea of (relative) mediocrity, sometimes punctuated by little islands of excellence. Further, the islands of excellence tend to be randomly distributed. They do not correlate with much of anything. This picture not only describes most public school systems around the world, it also describes most health care systems. (In fact, I can’t think of a single exception.)
The Apothecary and National Review Online posted a commentary by Avik Roy in which he suggests the debate “relates to one of the key justifications for Obamacare: that the rising cost of health insurance is largely due to the greed and incompetence of ordinary physicians, and that government alone can fix this problem. … It is about something more fundamental: Can government do a better job of managing medicine than doctors and hospitals can, or should the doctor-patient relationship remain sovereign? There is plenty of waste in medical care today, but the Dartmouth Atlas demonstrates that government is the problem, not the solution.” Roy gives a detailed rundown of flaws in the Dartmouth data.
Cato’s Michael Cannon says he “agree[s] with my left-leaning friends. This was shoddy journalism.” Cannon goes on to note that free-market advocates shouldn’t run from the Dartmouth data because “[s]o long as the Dartmouth research holds up to scrutiny, advocates of free-market health care reform should embrace it, for two reasons. First, embracing reality is generally a good idea. Second, the Dartmouth research makes the case for free-market reforms, and against the Obama-Orszag agenda. The Dartmouth Atlas focuses almost exclusively on the Medicare program, where economists of all stripes acknowledge that government-imposed price and exchange controls, coupled with a lack of patient cost-consciousness, are the driving forces behind persistent excessive spending and a lack of focus on value. ”
Elsewhere, Boston Health News hosts a new “killer edition” of Health Wonk Review.
And a new nonprofit, nonpartisan organization focusing on free enterprise and led in part by James Capretta, a former official in the Office of Management and Budget, has launched a site called ObamaCare Watch.