Debate heats up over regional differences in Medicare spending

Among the countless thorny issues legislators are facing as they struggle with health reform is the issue of why different areas of the country seem to differ so radically in how they spend their healthcare dollars.

The latest evidence fueling this ongoing dispute comes from CMS data listing communities--such as New York City and Boston--which seem to provide better care at a lower cost. A piece in The New York Times notes that Medicare costs there are actually just below  the national average when adjusted for factors like the regional cost of living.

In theory, policymakers should be able to study communities where high-quality, lower-cost care is common and bake what they learn into reform legislation. In practice, however, rural doctors and hospitals, not to mention policymakers, object to the idea that reform legislation should follow an urban model.

The bottom line seems to be that while there's been much worthy discussion of where high-quality, lower-cost care can be found, and even good research into why some regional or provider-specific models are working, there's little that policymakers or industry executives can pick up and generalize across the board everywhere in the U.S. It's a scary time for reform when so many of the basic premises are still so exploratory, but there you have it.

To learn more about this issue:
- read this piece in The New York Times