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Effectiveness Plan Raises Questions

Richard L. Reece, MD

April 2009
Commentary

Last month, the federal Department of Health and Human Services announced the members of the Federal Coordinating Council for Comparative Effectiveness Research. Comparative effectiveness research (CER), for better or worse, has arrived. Occasionally, an idea surfaces that seems so simple, rational, and scientific, that it may be too good to be true. CER is such an idea.

The plan is to develop a national institute that uses data to compare the effectiveness of various medical procedures and courses of treatment, find out what works and what doesn’t work, and pay only for what works. This idea is so compelling that the White House has earmarked $1.1 billion to develop the institute. Many observers have expressed optimism that CER will help to contain health care costs by identifying those treatments and systems that are most effective.

Perceptions Vary
How one perceives what needs to be done, or to what lengths one needs to go to control costs, depends on where one sits. Physicians have become paranoid that the government will be practicing medicine and not paying for procedures the bureaucracy deems inappropriate or ineffective, even though patients and others may think otherwise. From the perspective of payers, it appears that too much care is being delivered already. To physicians and patients seeking the best care, it is important that health care providers do everything possible to treat patients, even if doing so is economically infeasible.

Given the way CER has been reported in the media, many ordinary people and even some doctors are wondering why patients would oppose a plan to use objective data to show which treatments work. Peter Orzag, the White House budget director, has certainly embraced the idea, in part because he recognizes more than most that Medicare represents 25% of the ....

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