HEALTH CARE REFORM
High-cost cities should learn from low-cost areas
Not surprisingly, some doctors and hospitals in high-cost areas such as Los Angeles are resisting the idea that they can reduce health care costs by adopting medical practices of low-spending regions ("A health care fix too good to be true," July 29). They offer a variety of arguments to defend their high spending. I believe these arguments are misleading.
Argument No. 1: Comparing California to Minnesota is unfair, and payment reform is simply an attempt to benefit providers in Minnesota. In relative terms, the proposed payment reform is likely to offer greater benefit to South Dakota, North Dakota, Hawaii, Iowa and Maine than it is to Minnesota.
Argument No. 2: Los Angeles patients are sicker and therefore consume more health care resources. In February 2008, Peter Orzsag, as director of the Congressional Budget Office, reported to Congress that three previous studies of patient health status found that patient differences explained less than one-third of the regional differences in Medicare spending.
Argument No. 3: Medicare spending is high in Los Angeles because it has large poor, minority populations. Medicare spending in Los Angeles is more than 30 percent above the national average. In contrast, Medicare spending is at or near the national average in several other cities -- for example, Cleveland, Buffalo, Pittsburgh, Milwaukee and El Paso -- that have substantial minority populations and median incomes that rank them far below Los Angeles.
High-cost areas are generally limited to a few geographic regions within just 10 states. These areas often provide lower-quality results as well. Several legislators have introduced bills to adjust the Medicare physician payment system so that it appropriately rewards high-quality, affordable care. I believe that these payment adjustments will encourage caregivers to change their behavior, leading to lower long-term costs for everyone.
DR. RAY GIBBONS, ROCHESTER;
MAYO CLINIC HEALTH POLICY CENTER
TOWN HALL DISRUPTIONS
Colbert tells the truth;
why can't the Strib?
When Stephen Colbert can spend five minutes of his show lampooning a memo from the organizers of the "grass-roots" disrupters of congressional town hall meetings, I am astounded that the Aug. 6 article "Democrats getting an earful on health care during recess" did not report on the organized efforts to disrupt these meetings. As Colbert said, "we don't need to be a majority, we just need to say it" as he showed a pie chart of support for health care reform with a majority supporting some reform.
