President Obama's health reform plans are beginning to emerge in proposed legislation, and the predictable opposition has begun to coalesce in an effort to defeat many of the provisions which threaten these traditional interest groups. I've been somewhat amazed by the intense campaign that is underway to criticize and oppose what would seem to be one of the least controversial elements of the health reform plan, the $1.1 billion to support comparative effectiveness studies (CER) that was allocated earlier this year. CER is an effort to determine which treatments, including drugs, are more medically and cost-effective than others for a given condition or diagnosis. This sounds logical to me. After all, isn’t the analysis of cost versus benefit a fundamental principle of our free-enterprise, competitive market, economic system in determining the value of our goods and services?
Critics of CER are very willing to point to the danger of the rationing of health treatments as one of the consequences of CER. Some conservative and libertarian commentators go even farther by deeming CER the first step towards socialized medicine. An article in The New York Times identifies the Partnership to Improve Patient Care as a lobbying group backed by “organizations that represent producers of drugs, medical devices and biological treatments” which intend to confront the CER initiative. Critics are very willing to refer to the British National Institute for Health and Clinical Excellence agency as an example of how comparative effectiveness research can lead to unacceptable consequences for a nation’s health system. Interestingly, both Germany and Switzerland – countries whose health systems most resemble ours – have government-sponsored organizations that perform the same function as the proposed CER panel…yet haven’t appeared to be the undoing of healthcare in those countries.
I believe there are two reasons CER is receiving such attention from opponents of meaningful and affordable universal coverage and health reform. First, it marks the first salvo in the continuing fight that health coverage expansion and reform have faced since 1945, when introduced by the Truman administration, through to the Clinton administration’s effort to pass the Health Security Act. All of us – healthcare providers, suppliers, insurers and patients – are very willing to support the extension of health insurance coverage as long as attempts to make it affordable do not impinge on our economic or personal self-interest. Unfortunately, this attitude will ensure the defeat of any meaningful and effective reform.
Secondly, I’d submit that the focus on CER marks a dramatic change in the strategy of the traditional opponents of health reform. The Harry and Louise campaign used to convince the American public its healthcare insurance was at risk from the Clinton health legislation is the strategy of the last health reform war. With the marked decline in the number of insured since 1994, there are many more Americans who are uninsured or believe their health insurance is inadequate. They are not concerned with losing something they don’t feel they possess.
The fight against CER is moving to a new battleground. The theme will be that Americans are at risk of losing their access to all the marvelous drugs and procedures that can only be available to them if providers, suppliers and insurers remain free of any challenges to their judgment of what is clinically effective without having to confront the results of clinical effectiveness studies.
Yes, we have met the enemy of health reform and it is us.