A new study published in the New England Journal of Medicine has concluded that “treating some heart attacks with drugs alone is less costly and as effective as using stents“:

The study found that patients who received stents stayed in hospitals 1.2 days longer than those who received medication. The average cost of care for stent patients during the first 30 days of treatment was $22,859, compared with $12,683 for those using only medication, according to the study. The cost difference narrowed after two years, but patients using medication alone saved $7,000 on average. According to the study, an estimated 100,000 heart attack patients in the U.S. do not need stents, which could translate to savings of $700 million.

We spend about $700 billion on treatments that just don’t work, and comparative effectiveness research (like this) is just one way to chip away at the waste. As Dr. Sean Tunis of the Center for Medical Technology Policy pointed out a recent AEI event, creating evidence “that allows patients and clinicians and payers to compare risks, benefits, and costs of alternative health care interventions is that that information is essential for informed decision making and informed decision making by consumers is essential for markets to work efficiently.”

In an interview with the Politico’s Ben Smith, Peter Orszag offers some valuable insight into the Obama administration’s plans for health care in the budget.

According to Orszag, “the moves in the stimulus package are just a hint of what to come in a budget that will begin in earnest the arduous process of health care reform.” The administration plans to unveil “What has already been accomplished is a huge start toward a more efficient [health care] system, and I think you’re going to see more in the budget next week,” [Orszag] told Politico:

Though the budget’s details have been closely held, Orszag revealed, in broad terms, two: A continued focus on health care policy; and a plan “to restore the nation to a sustainable fiscal trajectory over the five-to-ten year window.” The next step on health care, he said, is a set of “changes to Medicare and Medicaid to make them more efficient, and to start using those programs more intelligently to lead the whole healthcare system.”

With a growing body of research finding some practices more cost-effective than others, the programs reimbursement rules can be used to force changes at those hospitals – a sort of back door to health care reform.

By applying reimbursement reform and other cost effective measures to Medicare and Medicaid, Obama hopes to reduce spending in the public health sector and basically muscle health care providers into changing their business practices.

But this plan “to restore the nation to a sustainable fiscal trajectory,” sounds like an incremental approach to expanding coverage. Economists have argued that real push for getting everyone into the system will require a large upfront investment, with savings accruing down the road. You can’t offer universal coverage and balance the budget. But down the road, you can’t achieve fiscal responsibility without fundamentally reforming the health care system.

Top advisers to President Obama are telling the New York Times that Gov. Kathleen Sebelius (D-KS) — the former insurance commissioner and two term blue governor from a red state with a knack for bipartisanship — is Obama’s top choice to head the Department of Health and Human Services:

It remained unclear whether the White House would finish vetting Ms. Sebelius in time to nominate her by next week. Advisers described her as “the leading candidate,” although they said other names were still in discussion and emphasized that no final decision had been made.

While Sebelius certainly lacks Tom Daschle’s connections to Obama’s health team (and greater Washington), she is no stranger to the club. As a member of the National Governors Association’s executive committee, Sebelius led the health-care portion of the December 2 meeting with President Obama and Vice President Biden and has promoted the health care provisions in the stimulus. According to the AP, Sebelius has even budgeted “a small part of its federal stimulus money” to “add about 8,000 kids to the state’s Children’s Health Insurance Program.”

In fact, a review of Sebelius’ record suggests that she’s a practical proponent of Obama’s health principles, willing to pursue, promote and defend comprehensive reform, despite political opposition.

As Insurance Commissioner for Kansas from 1994 to 2002, Sebelius refused to accept contributions from the insurance industry and blocked a merger between Blue Cross Blue Shield of Kansas and Anthem, an Indiana insurer. The merger “drew opposition from many Kansas doctors, hospitals and nurses, as well as an advocacy group for poor and working-class families” and would have increased premiums “by $248 million over fiver years.” [Associated Press, 6/11/02] Sebelius, however, “turned the office of the Insurance Commissioner into an activist regulator, pursuing HMOs who denied care and pushing for cheaper prescription drugs for seniors.”

Sebelius continued to promote health care reform in the governor’s office, focusing primarily on cost containment. To improve efficiency, Sebelius ordered that all of the state’s major health care programs, including Medicaid, be “streamlined into a new business division called the Kansas Health Policy Authority” and launched the HealthyKansas initiative to promote prevention and wellness initiatives.

Moreover, the Governor’s Health Care Cost Containment Commission pursued many of the health care ideas incorporated into the stimulus. The commission included “representatives of the health care provider community, business community, health plans, legislators and other stakeholders in the health care community” and developed strategies to reduce unnecessary administrative costs and facilitate the adoption of a state-wide health information technology and exchange system.

The group explored ways to establish an “interoperable health information exchange,” created task-force to develop state-wide standards for health insurance ID cards, and formed a public-private partnership to plan and implement “a health information infrastructure capable of accurately and efficiently recording and tracking all aspects of health care delivery and payment.”

It wasn’t until January 2007, however, that Sebelius made a coordinated public push towards expanding health coverage for children under five. “We must commit ourselves to the goal that all Kansans will have health insurance and we must begin now,” Sebelius said during her State of the State address. “My budget takes an important step toward achieving that goal by making sure every young Kansas child has health coverage.”

While the effort ultimately failed, Sebelius’ decision to pursue expansion in the political jungles of Kansasian conservatism, suggests that the governor is more than capable (and willing) to fight the uphill battle for health reform. All in all, her ability to reach health policy decisions by soliciting the views of a broad spectrum of stakeholders suggests that she’ll be an important player in promoting Obama’s health reform agenda and a strong consensus builder.