Smart Bombs: Maintenance required soon

If cable news and talk radio were national parks, they’d be Yellowstone. Myriad pools of boiling anger that constantly hiss and vent. Stinks, too. On the trip back from a recent vacation, we took the gorgeous route between West Yellowstone and Bozeman that snakes through the Gallatin Mountains. As we hit little Big Sky, a warning sign flashed on my Toyota’s console: “Maintenance Req’d Soon.”

Yeah, that’s what you want to read in the middle of Montana. As luck would have it, I happened upon a Toyota dealership in Belgrade, where President Obama would land a couple of hours later to listen to hissing and venting at a town hall session on health care. As for us, we were well on our way to Missoula after a mechanic pointed out that our warning mechanism wasn’t reset after our recent service. In short, the car was fine.

If only it were that easy to reset the health care debate, which has veered seriously off track. Actually, it was never on track, because the focus has been on universal coverage and the proper way to deliver it, not on cost containment. This is like spin-balancing a set of bald tires.

Too much health care. Suddenly the people who used to be in charge of the country are very concerned about health care costs. What did they do about that when they had a chance? Nothing. Obama and Democratic leaders in Congress will join that group if they don’t get a handle on costs. They know this. They’ve seen or heard about the reports from the Dartmouth University researchers who have studied the wide disparity in health care costs in this nation. The leading factor in the kind of care you will receive is where you live. It ought to be based on scientific evidence that treatment actually is needed and works.

This is documented again and again in Shannon Brownlee’s book “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.” The book was published in 2006 and the facts and figures are from then. It’s doubtful much has changed since, except that costs have gone up. A small sampling:

•In Boise, back surgery was 300 percent more likely than in Manhattan. You had a 60 percent greater chance of back surgery if you moved from Tampa to Fort Myers, Fla.

•Arthroscopic surgery – later found to be ineffective for arthritic knees – was five times more likely to be performed in Miami than Iowa City.

•One of the Dartmouth researchers’ mothers was in very poor health and not expected to live much longer. Before her death, doctors ordered up a mammogram. There was no discussion about what would happen if she did have cancer. Treat her, even though she didn’t have long to live? They also tested her for cataracts. When she eventually collapsed at home, they tried heroic measures to revive her there and at the emergency room, even though she made it clear that she didn’t want that.

•Doctors in hospitals affiliated with Harvard Medical School were four times more likely to admit patients to intensive care units than their counterparts at Yale. Dr. Jack Wennberg of Dartmouth, who has made it his life’s work to point out the spending insanity in health care, drove home this point at a conference where he explained the different rates of ICU admittance between New Haven, Conn. (home of Yale), and Boston (near Harvard). Before presenting the stunning disparity, he deliberately switched the labels on the slides. The doctors from Boston smugly offered damning reasons why their counterparts from New Haven were so eager to fill up the ICU. Then Wennberg announced that he “goofed” and switched the labels back. Now the Boston doctors were saddled with their own explanations, and the New Haven doctors were secure in the knowledge that their more conservative and less expensive approach did not harm their patients.

Much venting and hissing ensued.

What’s clear from the current health care debate is that nobody in power wants to touch the issue of overtreatment. The system will remain sick until we do.