Real Friends of Health Care Reform
According to Nicholas Kristof (“Unhealthy America,” NYT, Nov 5), “Opponents of reform assert that the wretched statistics in the United States are simply a consequence of unhealthy lifestyles and a diverse population with pockets of poverty.” Well, it’s true – there are wretched pockets of poverty, and that’s the principal reason that our statistics are worse than those of other countries. But pointing out that poverty is a major source of poor health and that health care reform has failed to address the issues of poverty does not make me an “opponent of health care reform” (see “Questioning the Reform Agenda: How Poverty Affects Costs and Outcomes”). It make me an advocate for reform that will actually deal with health care spending; reform that will improve the health of millions of poor Americans who will never attain anything close to the health status that Kristof and I are privileged to enjoy; and reform that will lead to the kind of equitable society that Kristoff and his wife, Sheryl WuDunn, yearn for in their important new book, “Half the Sky: Turning Oppression Into Opportunity for Women Worldwide.”
How curious that supporters of reform see the need to minimize the impact of poverty on geographic variations. And how sad that, by failing to appreciate the role of poverty, the current reform legislation sets the wrong policy related to hospital readmissions, establishes faulty systems of bonuses and penalties related to geographic differences and decreases disproportionate share (DSH) payments on behalf of the poor. There’s a lot that’s right in the health care reform bills, but the negative impact they will have on hospitals and physicians who care for the poor has to be fixed. Then we could have real health care reform.
Buz Cooper MD 
Dr. Cooper:
Thank-you for all that you have done to reveal the statistical equivalent of ink-blot tests put forward by the folks at Dartmouth for what they are – profound distortions of reality that only look real when viewed through the prism of their ideological pre-commitments.
It has been clear from the get-go that the nominal goal, reducing regional variations in the cost and quality of care has been a pretext for a larger goal. That goal, of course, has been transfer control of medical care into the hands of a centralized bureaucracy where the only people “truly” qualified to administer it – academic partisans of single-payer medicine – can shape medicine to their liking.
All of your efforts here will likely be for naught if the current before Congress passes the Senate. I implore you – please, please, please pick up your phone and do everything in your power to persuade anyone that you know that is in a position to influence the passage of this bill to oppose it.
You know as well as anyone what the stakes are, and the hour is getting late.
Dartmouth is a little crazy, but I agree with Dr. Brent James that healthcare quality is an important focus for actualizing quality healthcare. The incentives are needed to get there. But, Dr. Cooper is a huge inspiration for doing it the right way and we must address the fact that there are two healthcare systems in our country. One for the insured and one for the uninsured. We cannot benefit the insured healthcare system with quality incentives at the expense of those less fortunate. Co-improving both systems is the goal and we really need discussion on capital hill about addressing socioeconomic determinants of health; like access to healthy foods, physical activity and most importantly the reproductive rights of young impoverished females. Please rebut,
Mike