Today, three separate House committees — Ways and Means Committee, Energy and Commerce Committee, Education and Labor Committee — released a single health care reform bill, the Tri Committee Proposal. In a press release announcing the legislation, the three panels with jurisdiction over health policy in the House announced that they had developed “a single bill that fulfills President Obama’s goals of reducing health care costs, protecting and increasing consumers’ choices, and guaranteeing access to quality, affordable health care for all Americans.”

Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers.

On the whole, the bill’s affordability measures are impressive. Full details are after the jump but the plan offers subsidies on a sliding scale (up to 400 percent of poverty) and opens up Medicaid to Americans at or below 133% of the federal poverty level. While I haven’t seen the cost-sharing details, the robust public plan that could use Medicare plus rates would be able to force private insurers to aggressively negotiate with providers and pass on savings to consumers.

Below is a comparison table of all three bills, full details of the Tri Committee’s proposal are after the jump:

Next week, all three committees will hold hearings on the legislation. Mark-up (each committee will hold three markups on the same bill) will begin in mid-July and the bill will likely go to the floor of the House before the August recess.

Details on the Tri-Committee bill: Read more

During yesterday’s mark-up of the HELP Committee’s ‘Affordable Health Choices Act,’ Sens. Tom Coburn (R-OK), Pat Roberts (R-KS), Mike Enzi (R-WY) and Orrin Hatch (R-UT) introduced multiple amendments preventing the government from using the results of comparative effectiveness research (CER). Responding to the Republican charges, Sen. Barbara Mikulski (D-MD) pointed out that existing language already prevented the new comparative effectiveness council from using the research to make coverage decisions:

We get into this cost. We get into this repetitive word, “rationing”, “rationing.” It goes over very well with focus groups, but it has no rational here. If you go to page 323 of the actual bill, where it says ‘Incorporation.’ We absolutely prohibit that this, anything related to the Center For Health Outcomes, otherwise known as comparative effectiveness, that there “shall not be construed as mandates for payment, coverage, or treatment.” It is in the bill. Page 323, lines 5 through 7.

Watch a compilation:

Republicans relied on a three-part attack. One, ignore the existing language and offer redundant amendments prohibiting the comparative effectiveness center from mandating that doctors prescribe ‘the best’ treatments. Two — this is a somewhat more coherent strategy — argue that the Center for Medicare and Medicaid Services (CMS) could use the information to make coverage decisions for Medicare. And three, if the government uses the comparative research results to establish best practice guidelines, then doctors who don’t follow the guidelines but rather consider the individual needs of their patients, could be liable for malpractice claims.

But even the last two arguments fall apart on close scrutiny. The government isn’t mandating that doctors adopt the results of CER and it is not rationing care. Each patient has his or her unique needs and the ultimate decision for how to proceed should be left to the doctor and the patient. Currently, approximately one-third of all treatments have never been proven to produce better outcomes; CER would provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care.

Moreover, far from establishing one-size-fits all medicine or dictating treatments, properly conducted CER will actually promote faster adoption of personalized care. As Alan Garber of Stanford and Sean Tunis of the Center for Medical Technology Policy point out, “far from impeding personalized medicine, CER offers a way to hasten the discovery of the best approaches to personalization, providing more and better information with which to craft a management strategy for each individual patient.” The new CER council and CMS seek to preserve a personalized approach — that is, allow doctors to make decisions based on a patient’s history and individual needs — while eliminating truly ineffective treatments.

CER results are rarely black and white and no one study should serve as a final word on a coverage decision. But given the amount of unnecessary, redundant and ultimately harmful treatments, the government has an interest in informing health care providers about best practices– and this is what the legislation does and our doctors want. More efficient medicine is better medicine, and anyone who wants to prevent the system from wasting money is in the pockets of the medical industrial complex that is getting rich while we get sick.

After all, the “art of medicine,” as Coburn calls it, already relies on certain standards and practice guidelines and physicians often incorporate their knowledge of the patient and clinical experience to offer a patient-centered approach, as such only about half of the recommended guidelines are followed. Ultimately, however, doctors are not superheroes; they should not be ignoring “standard protocols” or attempting to re-enact the heroics of Fox’s HOUSE. They are currently driven by a set of professional standards and procedures, and as patients, it is in our interest to encourage providers to incorporate certain guidelines (derived from CER) into routine practice. After all, “the last thing most Americans want from this wise use of taxpayer funds is more published research gathering dust on library shelves.”