Via Ezra Klein, Paul Krugman offers this excerpt from Mike Huckabee’s new book lampooning the Recovery Act’s investment in comparative effectiveness research — which compares clinical outcomes of alternative therapies used to manage the same condition:

Huckabee rhetoric is pretty standard Republican fare. Conservatives have long used comparative effectiveness research to further their claim that health care reform would ration treatments based on cost, impose a one-size-fits-all standard for medicine, and keep doctors from prescribing more expensive and effective procedures. But this line of reasoning is well contained to partisan political circles. Health care experts and scientists believe investing in this kind of research will provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care. Properly conducted, scientists think that CER will actually promote faster adoption of personalized care and provide “more and better information with which to craft a management strategy for each individual patient.”

The very obvious question when it comes to CER isn’t “who will get rationed.” It’s: if the government doesn’t base its coverage decisions on science or comparing the effectiveness of one drug or treatment against another, then what metric does Huckabee propose? Absent a credible source of sound scientific information, Medicare and Medicaid are wasting taxpayer dollars on treatments that don’t work or paying for medicines that achieve the same result as a cheaper alternative. Consequently, health care costs are increasing and 45 million Americans are uninsured. But Huckabee, Klein notes, supports this kind of “dumb rationing” rather than the “smart rationing” that is grounded in eliminating ineffective treatments through scientific research.

Democrats may have overstimated public enthusiasm for health care reform following passage of the Affordable Care Act in March (and underestimated the willingness of the opposition to move public opinion against the law). But they still believe that Americans will support reform once they begin receiving benefits in 2014. The first survey of consumers who receive subsidized health insurance in Massachusetts, which served as a model for national reform, suggest there is reason to be hopeful:

Eighty-six percent of those surveyed said they were pleased with the range of services covered and the quality of care available, while 82 percent had similar feelings about the choice of doctors.

The majority of patients — 81 percent — reported they had seen a doctor for regular care at least once since receiving coverage through the Commonwealth Care program, which is the state-subsidized health insurance program created for low- and moderate income residents under Massachusetts’ 2006 health care law.

The survey also found that some members did report experiencing challenges in scheduling doctor’s visits.

The state exchanges — or the new marketplaces for insurance — that will allow individuals and families to purchase comprehensive basic coverage will differ structurally from state to state, but these results may push more governors to consider the Massachusetts design. Federal regulators can also use the state’s high degree of satisfaction with the “range of services” to make some decisions about how best to structure a essential benefits package, which is widely seen as one of the biggest challenges in reform implementation.

During an Institutes of Medicine meeting in January, John Kingsdale — the former director of the Massachusetts Connector Authority — (Massachusetts’ version of the exchange) warned regulators against “overreaching” in detailing which benefits insurers will have to provide. “My experience suggests revisiting and learning from cases and some flexibility and even phasing in would all be very helpful as you go down the path of defining a minimum benefit that will be extremely controversial,” he said.