Map of life expectancy at birth from Global Education Project.

Thursday, November 04, 2010

More is still less

Among the attack ads that helped trash Democratic candidates for Congress was one that claimed [your Congressman's] vote for Obamacare cut $500 million in Medicare benefits. The proposition that Republicans are going to be more protective of Medicare benefits than Democrats is obviously absurd, but it is true that the PPACA reduces growth in Medicare spending that would otherwise have occurred through a couple of mechanisms, including eliminating giveaways to insurance companies through the Medicare Advantage Program and squeezing some provider reimbursements.

Since the Republicans claim they want to fix the long-term federal deficit problem, obviously they have to be in favor of reducing Medicare spending, but don't count on them for honesty or even the most basic rationality. Scaring people works, so that's what they do.

If you've been reading this blog, you know that spending more on health care does not equate to better health. Right now, in the U.S., the opposite is true, and here's one more piece of evidence. These investigators, writing in NEJM, find huge geographic variations in the rate at which elderly people are given inappropriate prescriptions. Some drugs basically shouldn't normally be prescribed to old folks at all, others are inappropriate for people with specific conditions such as dementia. I should know, my father was prescribed quetiapine, twice, even though my mother had given the nursing homes written orders that he should not receive it. (There is a black box warning against giving it to people with dementia.)

We'll worry about exactly WTF is wrong with physicians another time, but it turns out that in Alexandria, Louisiana, 44% of elderly Medicare beneficiaries receive high risk drugs, compared to 11% in the Bronx. Nope, no idea why.

But, inappropriate prescribing is not related to total spending on drugs, but it is more likely to happen in regions with high overall medicare spending. So higher medical spending, far from leading to higher quality prescribing, is associated with worse prescribing practices. Will older voters ever understand that Medicare spending can, and must, be reduced in a way that actually improves their health care?

Until we can get this idea across, those dishonest political ads will still run, and we'll still elect lying hypocrites to congress.

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