This is Buz Cooper at his blog:
Peter Orszag….. cited the fact that knee replacements are much more frequent in Milwaukee than in Manhattan, and he's right. But….. Milwaukee's greater use of knee replacements is not because nefarious doctors are bilking the system and that 30% of health care spending could be saved by stopping such waste.
The reason is that Milwaukee is within a cluster of states with high rates. They extend from Idaho to Michigan and from Kansas to North Dakota, but they don't stop there. High rates continue into Saskatchewan, which sits atop North Dakota and has the same high rates, and into Ontario, which sits above Michigan and shares Michigan's high rates. Knee replacement rates in these states and provinces average 70% higher than in regions with the lowest rates….. Saskatchewan and Quebec are as different as North Dakota and New Hampshire. How interesting that two neighboring countries with two different health care systems have identical patterns of geographic variation – a phenomenon that knows no borders…… more.