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Certainly The Way To Go

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.  

Greg Mankiw writes that the gas tax is not an issue that divides liberals and conservatives, but rather one that divides political consultants and policy wonks. I would put comparative effectiveness research (CER) in the same category.

Pretty much every health expert notes the insanity of spending $2.4 trillion on medical goods and services, when we so often are flying blind about the real value (let alone cost-effectiveness) of what we are buying. During the campaign, the Obama and McCain camps squabbled about nearly everything. I don't recall them squabbling about CER. Gail Wilensky, one of Senator McCain's top health advisors, is a key proponent of these methods.

Insurers and employers support CER, because they want to know whether that two-month in-patient adolescent psychiatry stay, that $20,000 back surgery, or that costly MRI will really help. Doctors want to know which patients really need the next-generation pain reliever when there is a familiar generic backed up by 20 years of safety and efficacy data. Patients have an obvious stake in this, too. CER provides key tools to improve patient safety. Closer to my heart, these methods provide an important vehicle to expand the provision of preventive care and other public health measures.

Not everyone agrees with me. For decades, medical device and pharmaceutical companies, along with several surgical subspecialties have bitterly opposed the use of CER in public policy, in some cases trying to de-fund federal agencies charged to do this work. By strange coincidence, the bitterest opponents of CER are often prominent purveyors of costly, unproven treatments, medications, and services.

Desperate to find traction against health reform, and to specifically thwart the use of CER, some of these same players have waged an Astroturf campaign that proves depressingly effective. Conservative provocateurs, including Betsy McCaughey, have written deceptive op-eds supporting this cause. It's easy to spread frightening memes about the use of CER by a nanny state to ration health care or to justify abandoning Grandma on the ice floe.

If you want to know what CER actually is, you should check out the Institute of Medicine's recent report on the subject, issued only last month. The report is filled with many examples of creepy socialized medicine, such as the recommendation that researchers "compare the effectiveness of primary prevention methods, such as exercise and balance training, versus clinical treatments in preventing falls in older adults."

This afternoon, the House Energy and Commerce Committee passed a Republican-sponsored amendment prohibiting the federal government from "denying or rationing" medical care based on comparative effectiveness research.

This isn't surprising. Similar riders have accompanied pretty much every piece of legislation that mentions CER. This still counts as another hypocritical victory for self-described fiscal conservatives.