Nauseated by the repeated citations of the Dartmouth study which shows physicians to be the genesis of all our health care woes I decided to do a novel thing-read it. Politicians, including the President, admittedly negligent in not reading the massive spending bills they have passed are not likely to have vetted this research before blathering away on how, in the words of Washington Post columnist Steven Pearlstein,   “It’s the doctors stupid.”

One of our liberal friends, Dr. Elliot Fisher of the non-partisan (satire) Institute of Medicine, is co-author of a perspective piece on the study published in the New England Journal of Medicine on February 26, 2009. He and his co-authors draw broad and unscientific observations about physician responsibility for regional differences in per capita Medicare beneficiary costs when it is more likely that patient population and cultural differences are more likely to account for much of the differences. These are my own observational opinions of course but they are just as well founded as Dr. Fisher’s and are tempered by the fact that I have actually lived in several of the areas cited and there is no extenuation for making cohorts of patients in such diverse areas of the country.

At the extremes of per capita costs are Miami, Florida and Salem, Oregon. The former represents the most expensive and the latter the least. For health policy wonks like Dr. Fisher it is amazing that such diversity is lost on him. Not withstanding that Oregon rations care, has assisted suicide and gives quality of life scores to patients determining who gets care and who doesn’t, Miami does not remotely resemble Salem. Considering Miami, mostly comprised of very elderly retired people, people of diverse cultural backgrounds and transients from other areas of the country, why would one even begin to believe that a doctor would practice in a similar manner there and in Salem? People in each area have completely different expectations of their health care system with Salem having probably the lowest being used to rationing or being given the option of being dispensed with.  Anyone who would make the statement, as Fisher et al did that-- “..there is no evidence that health is decaying more rapidly in Miami than in Salem.”—has never, ever lived in Miami. Unless Americans from all over the over crowded, over taxed Northeastern United States are flocking to Salem, Oregon this statement is pabulum.

The article also cites that physicians in high cost areas were also more likely to order tests and refer to specialist. Having worked as a doctor in Florida, this can partially be explained by the incredible litigious environment in that state in contrast to Oregon where, well, you get what you get.

Becoming familiar with Dr. Fisher, the Institute of Medicine, the Harvard School of Health Policy and all of the other liberal institutions adulterating the real solutions to health care reform with their bias is essential. I would encourage everyone concerned, mostly my physician colleagues, to take note of this study as in the coming weeks and months it will be referenced to until it makes you, like me, crave for an air bag.