NPR logo

'Comparative Effectiveness' In Health Care Debated

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
'Comparative Effectiveness' In Health Care Debated

'Comparative Effectiveness' In Health Care Debated

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


Earlier this year, President Obama and Congress decided to spend more than a billion dollars for studies showing which medical treatments work best. The results are intended to help policymakers figure out the best ways to spend health-care dollars. This work goes by the clunky name of comparative effectiveness research, and it's proving to be one of the more contentious parts of the debate over health care.

NPR's David Welna reports.

DAVID WELNA: Senate Republican leader Mitch McConnell says he has no problem with comparative effectiveness research, but he does have a problem with using its findings to restrict health-care options.

Senator MITCH MCCONNELL (Republican, Kentucky): Americans want their doctors to have clinical information on which treatments work best and which ones don't. But government bureaucrats shouldn't be able to use that information to determine what treatments Americans can or cannot get. That's a decision we currently leave between a patient and his or her doctor. And that's where it should remain.

WELNA: There is no American government entity dedicated to deciding which treatments patients can get, but one does exist in the United Kingdom. It's the National Institute for Clinical Excellence, or NICE. As the Senate health committee recently crafted its version of a health-care overhaul, New Hampshire Republican Judd Gregg railed against what NICE does.

Senator JUDD GREGG (Republican, New Hampshire): I mean, in the most crass terms, what they do in England is they say that a life is worth 20 to 40 thousand pounds a year. And then if the procedure exceeds that price, you don't get the procedure. And I don't think we want to go in that way, down that road, in this country. So, I think we have to have an absolute ban on that concept of rationing.

WELNA: Maryland Democrat Barbara Mikulski assured Gregg that comparative effectiveness research wouldn't be used here to limit health care options.

Senator BARBARA MIKULSKI (Democrat, Maryland): We're not doing it the U.K. way; we're doing it the U.S.A. way. And the U.S.A. way says it shall not be construed for payment, coverage or treatment.

WELNA: And Acting Committee Chairman Christopher Dodd added that the insurance industry already rations health care by limiting payments and denying coverage to people with pre-existing health conditions. Dodd said there is a need for comparative effectiveness research.

Senator CHRISTOPHER DODD (Democrat, Connecticut, Acting Chairman, Health Committee): But I don't know of anyone that believes for a single second that we ought to be rationing care to the point where we deny benefits to someone.

Mr. SEAN TUNIS (Former Chief Medical Officer, Centers for Medicare and Medicaid): Reducing spending in health care presumably means you're spending less than someone might otherwise want, and that's rationing.

WELNA: That's Sean Tunis. He was chief medical officer at the Centers for Medicare and Medicaid during the recent Bush administration. Tunis says comparative effectiveness research can be a useful tool, but the problem has always been how to use its findings without igniting a political firestorm.

Mr. TUNIS: You know, that's a process that, in this country at least, we've never figured out - a good, robust politically viable way to do that. You know, that's the kind of process I used to run at the Medicare program. You know, it's the third rail of health care. It's the process that is really always viewed as getting in between a doctor and a patient.

WELNA: The health-care bill that two House committees approved last week has a 24-page section on the funding and use of comparative effectiveness research. It creates both a center for doing such research and a commission for overseeing it. But the bill then adds this caveat: Nothing in this section, it reads, shall be construed to permit the commission or center to mandate coverage, reimbursement or other policies for any public or private payer. In other words, Congress is taking a pass on ordering that the research findings be used to cut costs.

New Jersey Democrat Rob Andrews, who chairs the House subcommittee on health, says Congress is doing the right thing.

Representative ROB ANDREWS (Democrat, New Jersey, Chairman, Subcommittee on Health): We think that the private-insurance marketplace, for competitive reasons, will adopt a lot of these changes, and that's why a mandate isn't necessary.

WELNA: But former Medicare official Tunis doubts anyone will heed the federally funded research if doing so remains optional.

Mr. TUNIS: There's plenty of opportunity for profit in health care without conducting your business efficiently. So, I'm not sure that just, left to the current marketplace mechanisms, there would be much natural incentive to use, you know, the comparative effectiveness research information.

WELNA: That could all change, Tunis says, if Congress would add incentives for the kind of health-care efficiency that relies on comparative effectiveness research.

David Welna, NPR News, the Capitol.

(Soundbite of music)

WERTHEIMER: You're listening to MORNING EDITION from NPR News.

Copyright © 2009 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.