Take the case of Miami vs. La Crosse, Wis. In 2006, using inflation-adjusted figures, Medicare spent $5,812 on the average beneficiary in La Crosse, compared with $16,351 in Miami. Yet an examination of health status in both places, adjusted for age, finds no evidence that the extra spending resulted in better care, Weinstein said.
"That's the enigma here," he said. "Less is more, and more isn't better."...
Many fear that the push to contain costs will result in rationing.
In today's system, "we don't ration care, we ration people," said Donald M. Berwick, president of the independent Massachusetts-based Institute for Healthcare Improvement. "We know that if you are black and poor or a woman, there are all sorts of effective interventions you are not going to get."
Though the transition would be painful and the politics treacherous, Berwick said it is possible to spend less on medical care and have a healthier nation.
"If we could just become La Crosse, think of how much better off we would be," he said.
This reminds me of Sen. Daniel Patrick Moynihan's last well-known essay, "Defining Deviancy Down" in 1993:
Leroy L. Schwartz, M.D., and Mark W. Stanton argue that the, real quest regarding a government-run health system such as that of Canada or Germany is whether it would work "in a country that has social problems that countries like Canada and Germany don't share to the same extent." ...In a 1992 study entitled America's Smallest School: The Family, Paul Barton came up with the elegant and persuasive concept of the parent-pupil ratio as a measure of school quality. Barton, who was on the policy planning staff in the Department of Labor in 1965, noted the great increase in the proportion of children living in single-parent families since then. He further noted that the proportion "varies widely among the states" and is related to "variation in achievement" among them. The correlation between the percentage of eighth graders living in two-parent families and average mathematics proficiency is a solid .74. North Dakota, highest on the math test, is second highest on the family compositions scale - that is, it is second in the percentage of kids coming from two-parent homes. The District of Columbia, lowest on the family scale, is second lowest in the test score.
A few months before Barton's study appeared, I published an article showing that the correlation between eighth-grade math scores and distance of state capitals from the Canadian border was .522, a respectable showing. By contrast, the correlation with per pupil expenditure was a derisory .203. I offered the policy proposal that states wishing to improve their schools should move closer to Canada. This would be difficult, of course, but so would it be to change the parent-pupil ratio.
I suspect, by the way, that there may be a health-related selection effect involved with oldsters in Eau Claire and in Miami. Perhaps the hardier or more stoic elderly in Wisconsin tend to stick it out in the frozen north while the more fragile or demanding tend to move to Florida?
I also wonder if the number of lawyers correlates with the expensiveness and inefficiency of services in a region? For example, the seemingly sizable number of lawyers in Los Angeles, combined with the deep pockets of the Los Angeles Unified School District, means that public education in LA appears to be badly hamstrung by consent decrees and by school administrations' not unrealistic fears of more lawsuits. Thus, school discipline is lower on the priority list than not getting sued over disciplining some kid whose mom is likely to sue.
Does Miami have a lot of lawyers?