Stimulus Provides Preview Of Health Battles Ahead

Prescription pills

hide captionA newly controversial provision in the stimulus bill calls for funding to study medical drugs, devices and procedures.

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In Washington, Republicans are already warming up their arguments against what they anticipate will be President Barack Obama's plan to overhaul the nation's health care system.

At issue is a heretofore bipartisan — and relatively noncontroversial — provision included in the massive economic stimulus bill about to clear Congress. It calls for $1.1 billion to study, in essence, how well various medical drugs, devices and procedures work.

Currently, prescription drugs and medical devices must show they are safe and effective before they can be marketed. But they don't have to prove they are better or more cost-effective than other treatments already available. Currently, there is little research in this country to compare whether drugs work better than surgery or other types of treatments.

Many experts say that finding out what works best could help both improve care and cut down on expensive care that doesn't work — as well as less expensive alternatives.

"More research on what works and what doesn't, tied to financial incentives to provide the higher-value care, could help to reduce costs without harming quality," said health economist Peter Orszag, who at the time of the comment was director of the Congressional Budget Office. Orszag is now President Obama's budget director. "We currently have a set of financial incentives just for more care. And we need a set of financial incentives for better care. And part of that requires knowing what better care is," Orszag said.

What Works Best For The Money

Boosting so-called "comparative clinical effectiveness research" was a key feature in the health care platforms of both President Obama, when he was a candidate, and his Republican rival, Arizona Sen. John McCain. In fact, one of McCain's top health advisers, Gail Wilensky, is widely considered one of the biggest backers of increased research into comparing what works in health care.

"This is a way to try to provide, first, the information, so physicians and patients have an idea of what they're likely to be getting," says Wilensky, a health economist and former Medicare official for the first President George Bush. By helping show which treatments are not just more effective but more cost-effective, such research "will also help us have more sensible reimbursement strategies that various payers can use," she says.

But it's that latter part that has Republicans up in arms.

"If the federal government spends, as this bill does, $1.1 billion to begin to figure out what treatments or drugs are more expensive, it's going to use that information to deny you and your doctor the right to get those treatments," says Rep. John Shadegg (R-AZ). "That's what I think people are very concerned about, as well they should be."

Even Rush Limbaugh has joined the chorus, devoting time on his radio show earlier this week to the issue — and to a discussion of another part of the bill related to the office overseeing the transition to electronic medical records.

"The national coordinator of health information technology will monitor treatments that your doctor gives you to make sure your doctor is doing what the federal government deems appropriate and cost-effective," Limbaugh told his millions of listeners.

Limbaugh — and other conservative critics — haven't mentioned that there has been a national coordinator for health information technology since 2004, when the office was created by President George W. Bush.

Just Being Contradictory?

But Robert Blendon, a professor at the Harvard School of Public Health and an expert on health care and public opinion, says it doesn't matter that conservatives are glossing over some technicalities of the debate. Their real goal, he says, is to shape public opinion about a health care issue most of the public hasn't even heard of — and to make sure the public opposes what the new president wants to do.

Blendon says he was actually surprised the issue of health care has cropped up in a debate over what's essentially a jobs bill.

"The importance of it coming out here is it does send a signal to what that debate [over health reform] is going to look like and how contentious it's going be, even about issues that people don't fully understand," he says.

And while this may be just one small skirmish in a very large stimulus bill, he says, it could well be for Republicans the beginning of a focus they're going to take that any reform plan put forward by President Obama "could lead to rationing."

One thing that's very clear from the early debate, Blendon says, is that the new president's early hopes for bipartisanship in health care are being dashed.

"We're going to be in an era where the parties see things very, very differently and they're going to take very different stands. And health care is going to be a pivotal point," Beldon says.

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