The New York Times is warning that the urban patients may feel the pinch of the health care bill as it tries to rein in out of control health care costs. It notes that the goal of the bill is to cut Medicare costs by 15-30% by restraining the hospitals that cost the most. As it turns out, these hospitals are located mainly in urban areas like New York and Los Angeles. The bill will mandate that an independent body, such as the Institute of Medicine, will be tasked with studying then mandating that urban hospitals make changes in how they do business. Urban hospitals fear that they will be compared, as the Dartmouth group did, to the costs and utilization of hospitals such as the Mayo Clinic and other midwest institutions who have lower overheads and treat different types of patients. The real fear is that the IOM will recommend that the efficient hospitals will be rewarded with higher compensation while they are left with reductions. Wouldn’t that be a real kicker if the areas of the country that have supported health care reform the most,urban blue states, end up getting hurt the most by that reform.