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One of the more contentious issues in the stimulus bill was something that used to enjoy support from both sides of aisles. About a billion dollars of the bill is aimed at better understanding the effectiveness of medical treatments.

NPR's Julie Rovner has a story that could preview a broader health debate to come.

JULIE ROVNER: Experts say a key reason for the run-up in healthcare cost is new technology. And a key reason for that is when a new drug or device comes on to the market it only has to prove that its safe and effective, not that it's better or more cost effective than a drug, device, or treatment already in use. That's why there's been a call in recent years for more of what's known as comparative effectiveness research.

Dr. GAIL WILENSKY (Health Economist): It is what works, how well, for whom, under what circumstances provided where. That's what it's all about.

ROVNER: That's Gail Wilensky. She's a health economist and former health advisor to the First President Bush and to last year's Republican presidential nominee, John McCain. She's been among the leaders pushing for more government funding for research to compare medical treatments.

Dr. WILENSKY: This is a way to try to provide, first, the information so that physicians and patients have a better idea of what they're likely to be getting. And it will also help us have more sensible reimbursement strategies

ROVNER: Until last week support for the concept was broad and bipartisan. About the only people who weren't totally behind the research were makers of prescription drugs and medical devices. They're afraid that some of their products that might not measure up might not get paid for.

David Nexon of Advamed, the trade group for the medical device industry, says his group actually does support the $1.1 billion included in the stimulus bill for comparative effectiveness research, but they remain worried.

Mr. DAVID NEXON (Senior Executive Vice President, Advamed): The biggest concern really is whether comparative effectiveness research, which we think of as being clinical effectiveness to help patients and doctors make decision, becomes cost effectiveness research - which, in our view, is a way to ration care.

ROVNER: And just like that, rationing has become Washington's new buzz word. Now it's not just the medical industry that's opposing the research, Republicans off all stripes are demonizing the previously popular proposal. John Shadegg is a Republican congressman from Arizona.

Representative JOHN SHADEGG (Republican, Arizona): 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.

ROVNER: Even Rush Limbaugh has waded into the fray. Here's how he put it on his radio show last Monday.

Mr. RUSH LIMBAUGH (Conservative Radio Host): Right now, a lot of you get all upset at your insurance company because just they say, well, certain things will be covered and others won't, and you want it to be left up to the doctor. Try the government being in charge of what the doctor can do.

ROVNER: So what explains this sudden interest in something as arcane as comparative effectiveness research?

Prof. BOB BLENDON (Harvard School of Public Health): This is the first cannon shot for what the debate about health reforms will really look like.

ROVNER: Bob Blendon, of the Harvard School of Public Health, says Republicans are trying to define the terms of the coming health debate - even before it begins - by taking advantage of the public's ignorance on the subject.

Prof. BLENDON: Average Americans would not know what effectiveness research was or exactly what the billion dollars that's in the stimulus package is for. And if they hear one set of arguments - that it actually could be harmful - they can easily swing that way. And if they hear arguments that it's a way of giving information where their health insurance, for instance, will be lower in the future, they would think it was a very positive thing to do.

ROVNER: But one thing is clear. Unless something dramatic changes, President Obama's prospects for a bipartisan health overhaul bill aren't looking very good.

Julie Rovner, NPR News, Washington.

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