In his weekly radio and Internet address this past weekend, U.S. President Barack Obama lashed out against critics making “phony claims” about his health care reform bill. He urged “an honest debate, not one dominated by willful misrepresentations and outright distortions”. To be sure, the debate on health reform south of the border has been hotly debated. Angry crowds have jammed into town hall meetings across the country. At some of these meetings, the confrontations have even turned physical. Some people call the reform bill socialist, others call it fascist. The problem is that there has been a lot of emotion but not a lot of context. One of the central features of the bill is the idea of saving dollars through the targeted cost-cutting of Medicare, a government health insurance plan available for Americans 65 and over. These cost-cutting proposals were inspired by some controversial studies at the Dartmouth Institute for Health Policy and Clinical Practice. The studies wowed people in the Obama circle by showing how government could cut Medicare spending by hundreds of billions without affecting quality of healthcare delivery. How did they arrive at these conclusions? The studies found that when it came to end-of-life care, some regions spent more than others on Medicare. The “great discovery” was that the ones that spent more had no major difference in patient outcome than the lesser spending regions. To make a long story short, the Dartmouth Institute championed these lower spending regions as models that should be emulated by the rest of the country. The higher-spending regions, according the studies, have no justification for spending more because other regions get the same results with less. Therefore, there should be essentially the same budget ceiling applied to all care across the country. Sounds reasonable, right? But hold on a second. One glaring omission in this study is that it fails to take into account data such as the economic status of the patients. For example, the least expensive medicare facility in America is the Mayo Clinic in Rochester, Minnesota. The most expensive facility is found at the New York University Medical Center. Huge socio-economic differences between these two areas were simply ignored in the Dartmouth studies, even though it is well known that economic conditions have a huge impact on health. For example, lower-income people are more vulnerable to chronic diseases, which are extremely costly to treat. The study also didn’t take into account the amount of family support a patient has, which is important because those with more help at home can have more home-care rather than rely on expensive overnight stays at the hospital. If this cost-cutting proposal is passed in the reform bill, the poorest are the most likely to suffer. While President Obama laments his critics, one wonders whether he has been critical enough of the ones advising him.