Health care blame game or shell game?

The numbers in the rawest form are jaw-dropping. A relative handful of doctors – about 2 percent – account for one-quarter of the $77 billion Medicare paid out in services in 2012. One doctor in Florida received $21 million while 30 doctors in Massachusetts accounted for $45 million in Medicare payments that year.

The data are the most extensive ever released by the nearly 50-year-old federal program and appear to confirm what many have said about the health care system in the country: The elderly and poor are among the highest-cost patients in the system to treat. The New York Times on Wednesday found that the largest recipients of Medicare payments were cardiologists, ophthalmologists, and oncologists, three areas generally associated with diseases and health problems afflicting the elderly. The Times has also posted a searchable site for the 880,000 providers who received payments in 2012, sortable by name, specialty, and city. You can see what your own doctor received or what all oncologists in Boston made.

A number of media outlets parsed the numbers for relevance to their readers.The Boston Globe, for instance, analyzed the dataset and found that of the state’s 30 highest-paid doctors, half were ophthalmologists, who account for less than 2 percent of the licensed physicians in the state.

The problem with the data, which was released after a lengthy legal battle between the Wall Street Journal and the Centers for Medicare and Medicaid Services, is that theydo little to explain the costs or offer insight as to where savings can be achieved or give reasons for why costs are high. The wide net lumps in doctors who have been criminally charged with fraudulent billings together with doctors whose reimbursements seem high but can be explained by overhead such as support staff, imaging devices, and expensive therapies and treatments such as medications.

One Brookline ophthalmologist who received $2.7 million in payments in 2012 told the Globe less than a third of that was for fees, which was used on overhead and staff. The rest, she said, went toward imaging and costly injectable drugs, such as Lucentis, used to treat macular degeneration.

But the New York Times today has a follow-up story that says while Lucentis is an expensive drug, the manufacturer issues healthy rebates to doctors who use it. In addition, a single vial can treat three or four patients and some doctors have billed Medicare each time they treat a patient, getting $6,000 to $8,000 for a vial that costs $2,000. Doctors insist they make little profit because Medicare regulations cap their mark-up at 6 percent. But that 6 percent is a lot higher on a $2,000 vial of Lucentis than it is on a generic alternative called Avastin, which costs $50 a vial. A 2011 Inspector General’s report said if Avastin had been used over a two-year period in 2008-09 instead of Lucentis, the government could have saved $1.1 billion.

Like everything else in the health care debate, it all will go back to Obamacare, the derisive name given to the Affordable Care Act by opponents. The initial objective of universal health care was to spread the cost of treatments among all citizens, young and old, sick and healthy. The idea, sort of Social Security for the infirmed, is that money from younger payees who are less likely to require doctor visits will offset the high costs of treating the elderly and poor. And as the younger premium payers get older and need services, the next generation will move in and provide that foundation.

One way President Obama was going to cut the costs of health care and use his health plan to reduce the deficit was to cut Medicare and Medicaid reimbursements to providers by 24 percent. But that plan has been put off by Congress several times after lobbying by hospitals and doctors that such a drastic reduction would cause a mass exodus of physicians who would be unwilling to tre3at patients at such a low rate. Perhaps now we’re seeing why.

As raw as the numbers are, they have a good chance to spur a substantive debate about the costs of health care.

–JACK SULLIVAN

BEACON HILL

The Massachusetts House unveils a budget that increases funding for local aid slightly and provides $61 million in news spending for state colleges, the Associated Press reports.

A bill to revamp the state’s domestic violence laws that was passed unanimously by the House is drawing concern for a provision that would not only protect the identity of victims but require police to withhold the names of a family or household member charged with the abuse.

Gov. Deval Patrick plans to introduce legislation today to ban noncompete clauses that prevent workers from jumping to rival companies. CommonWealth highlighted controversy over the noncompete clauses in 2009.

A new law requiring teachers and childcare workers to provide fingerprints and undergo background checks is stirring a debate about who should pay for these initiatives — employers or employees. In Methuen, the cost to run checks on teachers is expected to cost $40,000, the Eagle-Tribune reports.

MUNICIPAL MATTERS

Lynn Mayor Judith Flanagan Kennedy is hopeful city letters from 1995 may help the city avoid paying $8.6 million more in school spending, the Item reports.

Cambridge rolls out a pilot program for curbside composting — the first such municipal program on the east coast.

Somerville narrows its search for a Union Square redeveloper to four firms.

CASINOS

The Lynn Item runs an editor’s note from CommonWealth on the head-to-head competition between Mohegan Sun and Wynn Resorts for the eastern Massachusetts casino license.

NATIONAL POLITICS/WASHINGTON

Joan Vennochi revisits the arc of George H.W. Bush‘s political career and views on taxes and other topics, and finds he is somewhat less of a “profile in courage” than will no doubt be claimed next month when he is bestowed the annual award that carries that name by the John F. Kennedy Library.

Slate asks whether America is becoming Mississippi.

Harvard Law professor Lawrence Lessig assails what he calls the nihilist resignation over campaign finance reform. Lessig detailed his critique of federal campaign finance rules in a CommonWealth conversation last year.

ELECTIONS

Attorney General Martha Coakley maintains a comfortable lead in a new poll on the governor’s race by the Western New England Polling Institute.

Inside Evandro Carvalho’s victory in the 5th Suffolk Democratic primary.

Scott Brown makes his candidacy against New Hampshire Sen. Jeanne Shaheen official today and Keller@Large says it’s already setting up as one nasty battle from now until November, assuming Brown wins the GOP nomination.

BUSINESS/ECONOMY

Bank of America has agreed to pay $772 million in fines and refunds to settle a case with federal authorities who charged the country’s largest bank with using deceptive practices in selling credit card products and illegally billing customers for credit reporting and monitoring services they never received. It’s the largest refund extracted to date by the Consumer Financial Protection Bureau, established following the 2008 financial crisis.

TGI Fridays in Braintree was threatened with a one-day liquor license suspension after being cited with violating the state’s “Happy Hour” ban by offering reduced-price drinks on “Martini Wednesdays,” which their lawyer claimed was intended to be for the entire month but was misconstrued by servers.

Businesses are vying for retail space in the new Ferdinand building in Roxbury.

A federal judge ruled NOAA‘s “rollover” of unused fishing quotas is “a clever use of a marine thesaurus” that is a violation of regulations set up by the scientific research mandated by Congress.

EDUCATION

The state’s higher education commissioner, Richard Freeland, is taking a number of steps to address the college readiness gap in Massachusetts, but Gary Kaplan offers an alternative approach that continues to rely on standardized testing.

A New Bedford teacher who was threatened in a chair-smashing incident by a student who was upset she confiscated his cell phone is facing discipline for failing to report the alleged assault. The assault went viral when another student posted a video of it on Youtube.

Gloucester plans to lease a shuttered school from the Catholic Archdiocese of Boston for $14,000 a month, the Gloucester Times reports.

A Salem School Committee member accuses Mitchell Chester, the state education commissioner, of having a conflict of interest in pushing the state’s new standardized test, the Salem News reports.

Former Westfield State University president Evan Dobelle’s federal lawsuit against several trustees and higher education commissioner Richard Freeland advances.

Brandeis University is taking heat for withdrawing its offer to grant an honorary degree next month to a Somali-born women’s rights activist who has been sharply critical of Islam.

HEALTH CARE

A major stem cell study related to heart disease published by researchers from Brigham and Women’s Hospital is being retracted by the journal where it appeared because of concerns that the data are “compromised.”

TRANSPORTATION

After a brutal winter that turned some of the state’s roads into the crater-pocked surface of the moon, Gov. Deval Patrick has released $40 million for road repairs, including $30 million for cities and towns to fix potholes.

Berkshire companies are among the ones competing for an MBTA rail car manufacturing contract.

ENERGY/ENVIRONMENT

A company called Kinder Morgan draws a large crowd for an information session in Dracut on a proposed natural gas pipeline running from New York to the Massachusetts community, the Sun reports.

A Cape Wind opponent calls the proposed offshore wind farm a financial boondoggle.

CRIMINAL JUSTICE

The Russian government declined to provide the FBI with additional information it requested about one of the Boston Marathon bombing suspects, the New York Times reports.

At least 22 are injured in a mass stabbing at a Pennsylvania high school, Time reports.

A man arrested for an assault in the North End based on an identification by the victim criticizes police and prosecutors for acting before gathering all the facts. The charges were dropped after further investigation, but not before he was identified in numerous reports, NECN reports.

ANTIQUITY

Though hardly definitive proof, new findings lend further support to the idea that Jesus may have had a missus.

MEDIA

The purchase of the Anchorage Daily News by the upstart online Alaska Dispatch is winning praise in many quarters, but not everyone thinks it’s good news.

A California court rules that emails and other forms of electronic communication about public business are not subject to the state’s Public Records Act if they are conducted on private computers or devices, Governing reports.