My first thought when I read about the provision in the stimulus bill to allocate $1.1 billion to government-funded comparative effectiveness research (CER)was that perhaps the glaring conflict of interests at the FDA would be remedied. As the health care reform parts of the stimulus bill have been dissected by the media and special interest groups, the CER provision has received plenty of critique. As expected, the comments from libertarians and conservatives have been mostly negative, while the comments from liberals have been mostly positive (is there any issue anymore that isn’t divided along partisan lines?)
I just read through the Cavalcade of Risk, hosted by our friend Julie Ferguson at Workers’ Comp Insider. Included in the Cavalcade is an article by Joe Paduda at Managed Care Matters, pointing out that it makes very good sense to have the government pay for studies to determine effectiveness in medical treatment. He delves into the arguments about rationing that are popping up like mushrooms after a rainstorm. He addresses the fact that the government already conducts effectiveness studies in all sorts of other industries that it funds – why should health care be any different?
My vantage point in all of this is from the health insurance industry. There are plenty of people who advocate a purely free market approach to health care, and are complaining that the government shouldn’t be allowed to dictate that a particular treatment isn’t cost effective. But private health insurance does exactly the same thing. Joe points out that Medicare doesn’t pay for voodoo, snake oil, or rhino horn. (and if people want to call that rationing, so be it). I would add that private health insurance companies don’t pay for those things either. Scientists are constantly working to come up with new treatments for medical problems. My own family has our fingers crossed that someone will figure out how to reverse kidney failure and restore my father’s health. I am not opposed to medical research, new innovations, and out of the box thinking in medicine. But we can’t just pour money on every possible cure that comes along, without first devoting significant study to its effectiveness. Some “treatments” are downright harmful, and others are just too expensive to be sustainable in a public or private health insurance system.
So for those who would prefer that government remove itself from health insurance and health care reform, I would challenge you to try to find a private health insurance company that will reimburse providers for unproven, ineffective medical treatment. We work with all of the major health insurance carriers in Colorado, and they all take steps to make sure that the treatments they pay for are proven to the best of our current knowledge. It wouldn’t make any sense to do otherwise.
If the government can successfully set up a program to analyze medical treatments for effectiveness, there’s no reason to believe that such a program would not be in the best interests of the American people. The data could be used by both private health insurance companies and by government-run agencies like Medicare and Medicaid. I would urge the government to be careful to avoid conflicts of interest or medical-industry funding in their research (like having pharmaceutical companies pay the FDA to review new drugs). But if objectivity is maintained in the research, CER could be a good way to make sure that the hard earned dollars Americans funnel into the health care system are well-spent.