The Dartmouth Study, UCLA and Peter Orszag

Peter Orszag, Director, Office of Management and Budget


Today's New York Times has an interesting article that I think pertains to the current health care debate. Dartmouth University has done a study of how much certain leading medical centers spend on treatment for patients in the end-of-life period before death. The study zeroed in on the UCLA Medical Center for particular criticism. UCLA, which makes every effort to save the lives of its patients, was singled out by the study as spending huge and ultimately unnecessary amounts for patients who died. The study contrasted UCLA with the Mayo Clinic in Rochester, Minnesota, which reportedly spends about half as much as UCLA on dying patients.

As the NYT article points out, however, the Dartmouth study only counted UCLA patients who died, not those patients who recovered.


http://www.nytimes.com/2009/12/23/health/23ucla.html?_r=1&partner=rssnyt&emc=rss

What is of particular interest is that the article contains a quote from Peter Orszag, the Director of the Office of Management and Budget (OMB), who used the Dartmouth study to make a point about health care cost savings. An excerpt from the NYT article:

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

Now that the government is in the process of taking over health care in the US, does Mr Orszag's interest in the Dartmouth study indicate that in the future, government is going to insert itself directly into these end-of-life issues? Is the government going to start telling places like UCLA that they need to cut back on the extraordinary treatment they offer patients and revise their philosophy of doing everything possible for their patients? Let's cut to the chase; is rationing, in fact, just down the road?

I have previously written of my mother's final days, which we went through this year. When she, her doctor and I knew the time had come, she made the final decision to stop treatment, and I implemented her decision. There is certainly logic in saying that many sick and elderly people are going through expensive procedures and treatment that are merely prolonging the inevitable. Yet, if we are going to remain a moral society, this should remain an issue that is left to the patient, the family, the doctor and the spiritual advisor. These decisions cannot be left to bureaucrats in Washington. If we give them that power, health care rationing is a bureaucratic inevitability. In effect, people will reach a point when it is their "duty" to die. When that day comes, something in America will also die.

Count up the cost of that, Mr. Orszag.