Comparative effectiveness research

COMPARATIVE EFFECTIVENESS RESEARCH…. It’s always struck me as something of a no-brainer — comparative effectiveness research helps point to the most reliable medical treatments. To conservatives, though, CER is a nefarious scheme that will lead to bureaucratic overlords dictating which patients are eligible to receive which services.

This is especially relevant in the context of Medicare and Medicaid. Sens. Jon Kyl (R-Ariz.), Mitch McConnell (R-Ky.), and Pat Roberts (R-Kansas) introduced a bill yesterday to make sure the government doesn’t use CER to deny coverage for treatments deemed ineffective.

Paul Krugman helps highlight some of the more conspicuous flaws in the Republican senators’ approach.

1. Politicians who rail against wasteful government spending are taking action to prevent the government from reining in … wasteful spending.

2. Politicians who warn that the burden of entitlements is killing the federal budget are stepping in to block … the single most painless route to reducing the growth of entitlements.

3. They’re doing it in the name of avoiding “rationing of health care” … but they’re specifically addressing taxpayer-funded care. If you want to go out and buy a medically useless treatment, Medicare won’t stop you.

4. These same politicians are, of course, opposed to efforts to expand coverage. In other words, it’s evil for government to “ration care” by only paying for things that work; it is, however, perfectly OK, indeed virtuous, to ration care by refusing to pay for any care at all.

Yep, it’s that bad. In fact, Krugman may have missed one.

For Kyl, McConnell, and Roberts, it’s outrageous to think the government would withhold payment for ineffective medical treatments. But Jonathan Cohn asks a helpful follow-up: “Are Kyl and McConnell prepared to extend a similar ban to private insurers? After all, private insurers factor cost into treatment decisions all the time. Do Kyl and McConnell think that’s wrong, too — that cost should never, ever be factor? Or do they think it’s o.k. when the medical directors for your friendly neighborhood HMO — operating behind closed doors and under pressure to make profits — make these decisions?”

I have a hunch we know the answer to that one.

Post Script: For a refresher on CER basics, be sure to check out Hilzoy’s post on this from last month.