Out of the more than $800 billion in economic stimulus being considered by Congress, a provision to spend a little over $1 billion on comparative effectiveness research (CER) is drawing outsized attention from conservative critics.
George Will says that "CER, which would dramatically advance government control - and rationing - of health care, should be thoroughly debated, not stealthily created in the name of 'stimulus.'"
Today, The Wall Street Journal opines that "giving government exclusive control over electronic health information and reporting is a step toward 'comparative effectiveness' research. That in turn will be used to impose price controls and deny some types of medical treatment and drugs. And because government is able to skew the whole health system through Medicare and Medicaid, comparative effectiveness could end up micromanaging the practice of medicine."
If this were true, why would the National Business Group on Health urge Congress to support CER? (The Fortune 500 companies that are members of the NBGH aren't types that usually favor government-run health care.)
If this were true, why would ACP, which represents the very same practicing doctors who the WSJ says will be subject to micromanagement, support CER?
The answer is that rather than leading to micromanagement of clinical decision-making, CER has the potential to improve decision-making by patients and their physicians.
CER "will provide critical information to physicians and their patients to allow them to engage in an informed shared clinical decision-making process" concludes ACP in a 2008 position paper. It "has the potential to reduce unwarranted variations in treatment among providers, increase patient accuracy in expected treatment outcomes, and provide patients with greater comfort in the treatment choice made."
It isn't as if physicians and patients aren't already subject to controls and micro-management. Every day, decisions are made by insurers on which services will be covered. Doctors have to produce reams of paperwork to justify deviating one iota from the insurers' guidelines. But the processes used by insurers to decide what will be covered or not are done in widely inconsistent ways, lack transparency, and don't always rely on the best available evidence.
In my mind, CER isn't about giving the government control over health care, but giving physicians and patients transparent and evidence-based information to make their own decisions.
The WSJ usually sings the praises of "consumer-directed" health care. But how can patients direct their own health care if they and their doctors don't have access to the best available research evidence on the relative effectiveness of different treatments?
Today's question: Do you think that funding an independent effort to conduct research on comparative effectiveness will (1) help improve physician and patient decision-making or (2) lead to government micro-management and control over health care decisions?