During the debate surrounding the $787 billion stimulus law signed into law this week by President Obama, several Republicans and lobbyists for drug groups and the insurance industry strongly objected to a provision that dedicated $1.1 billion to researching the effectiveness of medical drugs and procedures.
Rep. Charles Boustany Jr. (R-LA), a heart surgeon, opposed the provision because he feared that the government would use the research to deny treatments to Medicare patients because they cost too much. In fact, “when the House Ways and Means Committee debated the stimulus measure, Boustany offered an amendment that would have prevented Medicare from basing coverage decisions on cost alone.”
Once it was defeated, Boustany went on the offensive:
– Federal bureaucrats will misuse this research to ration care, to deny life-saving treatments to seniors and disabled people. [NYT, 2/15/2009]
– Congress should fund research to improve the quality of patients’ medical care, instead of creating new barriers to deprive them of beneficial treatments. [Press Release, 12/12/2009]
Today, in an interview with Congressional Quarterly, Boustany revealed that he hadn’t read the final version of the bill, but would have “voted against the stimulus bill even if the comparative effectiveness provision had been written to his liking“:
While I see some value in doing research to see what’s the best clinical approach, taking into consideration cost and quality, I’m just deeply concerned about cost alone being a factor in making clinical decisions.
Had Boustany read the final language, he would have discovered that the legislation actually addressed his concerns. In fact, the bill states that the research will compare “clinical outcomes effectiveness,” not cost:
That the funding appropriated in this paragraph shall be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies through efforts that: (1) conduct, support, or synthesize research that compares clinical outcomes effectiveness, appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, and other health conditions...”
The conference report addressed the matter more boldly, “the conferees do not intend for the comparative effectiveness research funding included in the conference agreement to be used to mandate coverage, reimbursement, or other policies for any public or private payer.”
The stimulus legislation established an agency to “conduct and support research that would assess the benefits of competing treatments,” regardless of their cost. As Robert Laszewski points out, “comparative research–which drugs or medical devices work the best–makes a lot of sense. That is especially true in the wake of decades of research that continues to point to wide overuse of technology as the primary cost driver in our health care system.”
In the long run, comparative effectiveness research could be used to make health care more cost-effective. That is, to improve the quality of care, lower health care costs and make insurance more affordable, Medicare could spend health care dollars with “an eye to lifting the quality and reducing the cost of health care” without refusing “to pay for popular treatments that it covers today — unless the research reveals serious risks.”