A friend – a highly respected health economist – expressed concern that my criticism of the Dartmouth group’s studies “is a justification to do nothing.” I told him that I, too, have been concerned that my critiques might be taken that way, but they shouldn’t. What I have tried to do is to prevent the wrong things from being done. Regulations based on geographic variation will do nothing to improve the quality curve. Quality is not geographic. But poverty is, and despite the Dartmouth folk’s denial, what the studies of geographic variation demonstrate is that poverty is a major contributor to health care costs. That’s why Mayo shuns poor Medicaid and Medicare patients. However, I have had an even bigger concern – that the Dartmouth group’s twisted logic would eventually be figured out, and its close association with the Orzag-Obama plan would undermine health care reform. It’s difficult to conclude that this was the problem in Massachusetts, but “lack clarity,” “arrogance of ideas” and similar expressions of distrust with health care reform have been cited as reasons for the election’s outcome. Twisted truths are not a basis for sound policy. We’ve got to get this right if health care reform is to proceed on a rational basis.