The body of research cited by the Obama administration in its cost-cutting claims, the Dartmouth Atlas, has been criticized as being too limited and potentially less than accurate in the data it does provide, according to the New York Times.
Simply put, the 30-year-old Atlas only measures variances in Medicare and Medicaid spending from region to region, without regard to outcomes, the nature of the conditions in which the money is spent to treat or differences in how much that care costs from place to place.
While Dartmouth's research certainly is valuable and highly regarded in medical circles, critics of its use in overhauling the country's health system say that other measures, such as Medicare's own "Hospital Compare" survey, create a very different picture of U.S. healthcare.
"It may be that some places that are spending more are actually getting better results," argues Dr. Harlan M. Krumholz, a professor of medicine and health policy expert at Yale.
In response to the criticism, Elliot Fisher, Dartmouth Medical School Professor and Atlas Co-principal Investigator and Jonathan Skinner, a health economist at Dartmouth who works with him, have vigorously defended their work, saying that their critics fail to understand the issues and often make significant statistical errors.
And even if they adjusted more fully to reflect differences in regional costs and patients' health, they say, the overall effect on the atlas's findings would be relatively small. Nonetheless, the pair acknowledged that there was no link between greater spending and worse health outcomes, the Times reports.
In interviews, administration officials acknowledged that the Dartmouth Atlas was far from perfect. Peter Orszag, the president's budget director, says he does not rely on the atlas alone to prove that huge savings are possible. "What I have repeatedly said is that a wide variety of evidence suggests there is substantial opportunity for savings, and the challenge is in capturing that opportunity," he said.