CALPIRG Blog

There's been no shortage of arguments around the $800 billion stimulus package.  But one of the fiercest has hinged on a comparatively tiny piece of the package: $1.1 billion dollars for research into the comparative effectiveness of different health care treatments -- figuring what procedures, therapies, drugs, and devices are best at healing patients.

This kind of research will improve the quality of care patients receive.  But it's also critical to getting health care costs under control.  Families and employers know that monthly premiums are getting harder and harder to afford, and the overall picture is even more frightening. 

If we don't start reducing costs, by 2050 one out of every two dollars our whole economy produces will be devoted to health care, and before this century's out, health care will devour our entire GDP. 

A big part of the problem is that we don't get what we pay for: experts estimate that a third of spending on health care treatments doesn't provide any benefit to patients.  There are a bunch of expensive treatments out there that provide lower-quality care than less costly alternatives -- but we're bankrupting ourselves by continuing to pay for expensive waste.

There are three basic ways we can deal with this crisis: first, we could figure out which treatments are the most effective, and stop wasting money on the ones that don't actually help patients.  Second, we could do nothing, letting the price of quality care go up and up without limit.  Third, we could try to cut costs and limit spending without taking the time to understand what care is worthwhile and what isn't.

Only one of these approaches is likely to work.

But now pundits and representatives of special interests are making their way to the editorial pages to argue against figuring out which treatments help patients and which do not.  See here for a particularly good example.

Knowing whether treatment A or treatment B is better, goes the argument, will inevitably lead to government proscribing the sub-standard treatment, so that instead of being treated by your doctor, physicians will be mere intermediaries for medicine as practiced by the federal bureaucracy.  Advocates of this position never object directly to the research -- they just paint it as a step on the slippery step towards government rationing.

It's a compellingly dystopic vision, but one built on a staggeringly silly premise.  Suppose that we do some research and figure out that treatment A leads to better health outcomes and costs half as much as treatment B (you might think that the more expensive treatment would be better -- but with much medical "innovation" driven by copycat drugs and gimmicky devices, better is often cheaper.  See our report, Diagnosing the High Cost of Health Care, for more).

Wouldn't any doctor who cared about their patient go for treatment A?  And wouldn't those paying the bills -- patients, insurers, enrollees in private insurance, and the taxpayers who finance Medicare -- agree?  Better information will help us cut costs while improving the quality of care, no intrusive bureaucracy required.

So do critics of comparative effectiveness research really think that doctors aren't smart enough to understand the results of the research?  Or maybe they just don't think the research will pay off, because they think any treatment is just as effective as any other (they can get their tonsils out next time they've got a stomachache!)

Of course, the answer's a lot simpler than that -- and there are very few principled arguments in favor of a policy of ignorance.  All that wasteful spending, a third of health care dollars nationwide?  It goes to inflating the profits of powerful special interests, including but by no means limited to the pharmaceutical drug industry.  Bringing costs down by figuring out that some of the treatments they peddle aren't effective is a direct threat to those profits.

They're ready and willing to pour millions of dollars into a PR effort in order to keep the rest of us spending billions for unnecessary treatment.  And with momentum building for health care reform, the squabble over this pot of money for research is only the first shot in a much bigger fight.