I worked for a prestigious actuarial firm (not as an actuary). The actuarial review process includes what is unofficially called the "sniff test". Does the result make sense in light of what we know about other external factors? If not, the number crunchers are asked to go back to review their assumptions, their inputs, and their formulas.
This study fails the sniff test!
When the Institute of Medicine argues that upwards of 30% of US health care spending is wasted, and they list six categories of waste; and when it attributes much of that waste to the fragmented payment and delivery system; how can the Urban Institute assert that it will cost $17 billion.
It flunks the sniff test.
I cold go on.
But we should not expect the Urban Institute to renounce their study or to bite the hand that feeds it.
Rather it should be overwhelmed with critical and credible studies that detail its flaws and counter its conclusions.