Because the Dartmouth "agenda" is not a prescription.  DARTMOUTH IS A
DIAGNOSIS WITHOUT A TREATMENT.  Variations appear to be driven by supply and
by custom, and the practice patterns in the low-use areas are not based on
written guidelines that can be transferred to the other areas -- even if
that were politically possible.  

Ah well.  I forget if I shared the stuff linked below before.  But the only
way to savings in the medium term is to whack the prices and administrative
costs, and until last week none of the big wheel economists in the health
policy world were willing to say that.  Now Uwe and Paul Ginsburg have said
it on the Health Affairs blog, but fat lot of good that will do at this late
date.  Blue Dogs (and the Senate version -- maybe Running Dogs?) are very
conventional-wisdom-oriented.  If a cost control argument isn't something
they've been seeing for years, they won't buy it quickly -- even if it is
supported by all sorts of evidence.  The fact that it calls for government
direct regulation doesn't help either, of course.  Anyway, I've posted my
say on the realities of cost control at
http://ourfuture.org/healthcare/white.  But it means nothing coming from me,
and my sense of how political policy thinking works is, it's too late from
Uwe and Paul.

Best,
Joe White

Ps: As I argue in the posts, rate-setting is the best way, at least in the
medium-term, to get at the variations, too.

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On
Behalf Of Maynard, A.
Sent: Sunday, August 02, 2009 1:54 PM
To: [log in to unmask]
Subject: Re: WP Charles Krauthammer - Obama Will Settle for Less on Health
Care - washingtonpost.com

AS ever the nice issue is your reluctance to challenge the medical 
monopoly to eradicate waste e.g why do you accept the Dartmouth agenda 
is too difficult my dears? Spending more doesn't mitigate the 20%? 
waste. You are just like the limeys on this: pathetic!!!
Alan (Maynard)

Adam Oliver wrote:
>
> Thanks for your contribution David. I think you should suggest to the 
> next Presidential candidate that instead of using a slogan of “yes we 
> can”, they should use “no we bloody can’t”. A million people chanting 
> that down the Mall could be quite amusing.
>
> You Americans are becoming so pessimistic that anyone would think you 
> are British. I think it must be because you are losing an empire, but 
> are still assuming too many roles.
>
> ------------------------------------------------------------------------
>
> *From:* Anglo-American Health Policy Network 
> [mailto:[log in to unmask]] *On Behalf Of *David Wilsford
> *Sent:* 31 July 2009 18:34
> *To:* [log in to unmask]
> *Subject:* Re: WP Charles Krauthammer - Obama Will Settle for Less on 
> Health Care - washingtonpost.com
>
> Well, Adam, I think risk-sharing across generations is just fine 
> (that’s what any national-”ized” system does) and agree with Michael, 
> too, that it’s nothing new.
> Moreover, as I grow old (I hope) in the French system, I hope I 
> continue to get fantastic care at superbly reasonable pricing through 
> my French assurance maladie. (Although, the French authorities and I 
> agree that the whole system is harder to control that it would be with 
> much stronger gatekeepers for ambulatory care, for example, but the 
> French system has its own difficulties with sticky institutions and 
> path dependency!)
> However, sitting inside the Beltway half the year, instead of down on 
> the Mediterranean, I disagree with Joe’s assessment: Obama handed over 
> the details explicitly to Congressional leaders, so no surprise that 
> the result is a mash. Moreover, his “pay as we go” proposals, of 
> various kinds, to raise revenues, have been mainly sleight of hand. 
> Did you drink that Kool-Aid, Joe? The CBO has been right each time.
> Where I think that Krauthammer is on-spot in ways that many 
> commentators have not been is his laying out of how a modest version 
> of health INSURANCE reform — not health system reform — WILL happen 
> and then Obama will declare victory.
> Systemically, costs will not be reigned in, because no structural 
> changes will occur in incentive frameworks for users, providers or 
> payers and because no structural changes will occur in the structure 
> of paying itself, i.e., a single payer system (which, interestingly, 
> Gail Collins and David Brooks re-visit together yesterday in the NYT).
> But the great bargain that Krauthammer suspects will be struck between 
> the administration and health insurers (even though he is against it) 
> is indeed the best that can be hoped for now — and for many more years 
> to come.
> Yep, Krauthammer and Joe White are right, systemic change is a dead 
> letter now.
> And always was, I argued publicly in early February 2009: There is 
> only so much oxygen in the room, and the financial bail-out(s) have 
> sucked it all up, not to mention ratcheting up in Afghanistan while 
> ratcheting down in Iraq. (Afghanistan will dominate Years 3 and 4 of 
> this Obama term; it’s a losing deal the way it is being approached 
> now, and He made it His war.)
> Besides all this, it would help if someone in the administration 
> besides Larry Summers had actually read Madison’s Federalist No. 10. 
> The system that we observe at work on health care reform attempts is 
> precisely the way it was engineered to work by the so-called Founding 
> Fathers of the country.
> You want to change Washington? You must change the institutions — 
> which is not going to happen. It does not suffice to sing a happy song 
> around a table together. Or have four different kinds of beer at a 
> table in the Rose Garden off the Oval Office.
> Silly, when it comes to changing fundamentals, although making people 
> feel aglow inside is sometimes a nice extra. Just don’t mistake it for 
> real change, in health care or in race relations or in anything else.
> Là voilà.
> Cheers, friends.
> David
>
> -- 
> David Wilsford Ph D
> Professor of Political Science, George Mason University (Fairfax 
> Virginia USA) and
> Visiting Fellow, London School of Economics (UK)
>
> [log in to unmask]
> French cell +33.6.11.16.50.93
> U.S. cell +1.224.522.0111
> On 7/31/09 3:25 PM, "Joe White" <[log in to unmask]> wrote:
>
> Well, the values and angles he’s espousing come close to being evil. 
> And the piece is seriously misleading about what Obama has done. The 
> numbers refer to the House bill, not Obama’s proposals. Obama did not 
> have to “flip through” the tax code: he proposed a perfectly 
> reasonable way to find a lot of the money, namely changing the size of 
> tax deductions for high-income people, and those “fiscal 
> conservatives” who are looking for a “bipartisan” deal in the Senate 
> rejected it.
>
> That said, yeah, it’s dying on the vine.
>
>
> *From:* Anglo-American Health Policy Network 
> [mailto:[log in to unmask]] *On Behalf Of *David Wilsford
> *Sent:* Friday, July 31, 2009 8:18 AM
> *To:* [log in to unmask]
> *Subject:* WP Charles Krauthammer - Obama Will Settle for Less on 
> Health Care - washingtonpost.com
>
> Good Lord, I don't often agree with Charles Krauthammer, but I think 
> his analysis in this morning's WP has the next six months of this 
> process right on target.
> Yours
> DW
>
>
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073002
819_2.html?wpisrc=newsletter&wpisrc=newsletter&sid=ST2009073002826 
>
<http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR200907300
2819_2.html?wpisrc=newsletter&wpisrc=newsletter&sid=ST2009073002826>
>
>
> -- 
> David Wilsford Ph D
> Professor of Political Science, George Mason University (Fairfax 
> Virginia USA) and
> Visiting Fellow, London School of Economics (UK)
>
> [log in to unmask]
> French cell +33.6.11.16.50.93
> U.S. cell +1.224.522.0111
>
>
> Please access the attached hyperlink for an important electronic 
> communications disclaimer: 
> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm