Miami is to Minneapolis as McDonalds is to Le Bec Fin...

yeah, i had to look it up too

Some days it feels like Richard 'Buzz' Cooper and I are the only two people in the whole entire blogosphere [and maybe the whole entire planet] who are trying to skewer the Blair Witch Dartmouth Atlas Project, with the primary difference between us being that he's actually got the chops to do it.

Not to mention that he writes killer blog posts. I'll c&p the McDonalds one in its entirety just because I can:

Similarly Dead, Not Similarly Ill –
Quintesssential Dartmouth Doubletalk

Dartmouth Atlas Frequently Asked Questions:

“How do you ensure some patients were not more severely ill than others?”
“The study only focused on patients who died so we could be sure that patients were similarly ill across hospitals. By definition, the prognosis of all the patients in the cohort was identical – all were dead after the interval of observation. Therefore, variations cannot be explained by differences in the severity of individuals’ illnesses.”

So, let’s see. Dinner is similar at Le Bec Fin and McDonalds because the prognosis is the same – both are gone in a few bites. And out of this comes national health care policy. G-d help us.

Cooper, with more on logic and variations in health care spending:

The notion of “30% waste” has deeper roots in an invalid thread of logic that begins by characterizing regional differences in Medicare spending as “unexplained,” and because differences are “unexplained,” they must be unwarranted, and because they are unwarranted, they must be wasted. Logic dictates that, when differences are unexplained, explanations must be sought. In fact, when that has occurred, variation has been attribltable to differences in the prevalence of disease, patients’ risk factors, patients’ income, community characteristics and even altitude. Moreover, these pervasive and stubborn variations have been found in other developed countries, where health care financing and delivery systems are very different from the US.

Altitude! Whodathunkit? But this is what real scientists do, they actually go looking for explanations for the unexplained.

On to Miami [where I have lived] and Minneapolis [where I have also lived]. Miami is frequently reviled, based on nothing more than the Dartmouth Atlas, as a hotbed of greedy old farts sucking up all the health care and leaving none for the rest of us, and this has to be stopped.

Not so fast, says Cooper:

So how do Minnesota and Florida stack up? Minnesota spends more per capita, not less - 13% more. It’s not a low-cost haven. Minnesota has lower Medicare expenditures but, with fewer uninsured, good benefits plans and generous Medicaid, it spends more overall – and it gets more!

So just why do our old folks cost more than Minnesota's old folks? It's the poverty, stupid:

Although the Dartmouth folks grumble that “single working mothers in Nebraska are footing the bill for gold-plated health care provided to high-income Medicare enrollees in Miami,” it’s Miami’s poor who use the most. So, the message is that poverty is expensive to the health care system, including to Medicare , and like Chicago’s south side, south-Florida has lots of it, while Minneapolis has very little. Miami’s poorer outcomes reflect its burden of poverty and Florida’s overall under-investment in health care.

On the subject of how health care policy affects people in real life, Cooper is one who gets it. He's got more on poverty, and more on regional variations: McAllen vs El Paso [cf Atul Gawande] and Birmingham vs Grand Junction. The entire blog is well worth reading [he's only been blogging for a few months, so it won't take you long] if you're at all into health care policy wonkery.