After voting to repeal the health reform law, the House of Representatives passed a resolution to provide direction on the “replace” part of “repeal and replace.” The resolution instructed the health committees to develop legislation to replace the health care law with “incentives to encourage personal responsibility for health care coverage and costs” among other GOP ideas, like selling insurance across state lines.
Why in heaven’s name, then, are some influential House Republicans trying to end support for research to help people “to take more personal responsibility” for their own medical care?
Rep. Thaddeus McCotter (R-MI) has introduced H.R. 556, which describes itself as the “Preserving Patients Choice Act” even though in my mind the bill actually would reduce the ability of patients to choose wisely among different treatments. The bill would repeal funding for comparative effectiveness research (CER) conducted by the new Patient-Centered Outcomes Research Institute (PCORI) and by the Agency for Health Care Research and Quality. Rep. McCotter, the immediate past-chairman of the House Republican Policy Committee, says that “H.R. 556 would repeal . . . the Patient-Centered Outcomes Research Institute, an entity with the potential to inject the federal government into the doctor-patient relationship.”
But the PCORI was set up to help patients and their doctors make their own choices, not to impose decisions on them. This is how ACP described the PCORI in a statement submitted yesterday to a House Ways and Means committee hearing:
“Each day, in the privacy of the examination room, patients are treated for conditions for which there are numerous treatment options. . . The limited availability of valid data to supplement the physician’s clinical experience and professional knowledge – data that compare the clinical effectiveness of different treatments for the same condition – makes it difficult to ensure that an effective treatment choice is made, one that meets the unique needs and preferences of the patient. The ACA helps to address this issue by establishing an independent, non-profit, tax exempt corporation, known as the “Patient-Centered Outcomes Research Institute” to provide comparative effectiveness information to clinicians and patients. The law also funds the development of shared decision making tools to translate the results of the research into information that is understandable by patients . . . In this way, Medicare patients and their physicians will be empowered to make informed, and therefore improved, health decisions based on the best and most recent evidence of clinical effectiveness.”
Dr. Fred Ralston, ACP’s president, in remarks made at ACP’s State of the Nation’s Health Care briefing, put the value of such research in words that any physician or patient would understand:
“I look at rational use of resources on a personal level as obtaining and using the proper information on diagnostic and treatment options that I would want used on my family. If a test or treatment is shown to be superior to other options on the basis of safety, outcomes, and/or cost it is what I would want my mother, my wife or my sons to receive. We need unbiased research to make sure that physicians and patients have access to the best treatment options.”
The logic of comparative effectiveness research is simple: if patients and physicians have more information about the effectiveness of different treatments, they will be more likely to choose the ones that will work best them. An article in the current issue of the Annals of Internal Medicine notes that people often know more about consumer products than their own health care:
“The purpose of CER is to help patients, providers, and policymakers make more informed decisions about health care. As some observers have commented, consumers often know more about the pros, cons, and costs of televisions, cars, and appliances than they do about health care interventions. If CER also assesses utilization and costs, it can further help provide a foundation for cost-effectiveness analysis.”
This is not to say that the science of doing comparative effectiveness research is simple – it’s not – but the challenges involved in conducting such research speaks to the need to ensure stable and sufficient funding.
Fiscal conservatives, of all people, should embrace giving doctors and patients the information needed to “encourage personal responsibility for health care coverage and costs.” Providing patients with the results of CER could help drive down costs, by reducing some of the estimated $700 billion that the United States spends each year on ineffective care, while resulting in better outcomes for individual patients and the U.S. population.
In the absence of providing patients with information on comparative effectiveness, it is more likely that someone else – the government, the insurance company, or even a well-meaning but misinformed family member – will make treatment decisions for them.
In the absence of information on comparative effectiveness from trusted and independent scientists, it is more likely that patients will be influenced by slick industry-fund, direct-to-consumer ads for prescription drugs or motorized wheelchairs to seek treatments that they really don’t need and won’t help them, adding billions to the cost of health care.
And in the absence of information on comparative effectiveness, it is more likely that patients will be subjected to harmful and unnecessary tests and treatments.
Patients and physicians alike should urge Congress to preserve the funding for research to help people make more informed choices about their own health care, and remind conservative legislators in particular that such research will “encourage personal responsibility for health care coverage and costs”—an idea the GOP has said it intends to champion.
Today’s question: What is your reaction to the effort by some legislators to eliminate funding for comparative effectiveness research, which is intended to help people take personal responsibility for their care?