Comparative Effectiveness
Comparative effectiveness is a topic that is creeping up in the democrat / republican health care debates. Consumer Reports provides a good summary of what it is and the arguments for and against it.
In short, from what I understand, everyone agrees that it would be great for doctors to have access to credible, vetted information that helps them compare various ways to treat the same disease or condition. This would allow them to synthesize their own experiences with those of doctors around the country, along with research provided by independent organizations, to make informed treatment decisions.
My understanding is that the argument is over who does the research and analysis and whether it forces doctors to choose treatment choice A over choice B every time regardless of the nuances of a specific patient case.
Republicans want private markets to spend the time and money to do the research and make it available. Their argument is that an enterprising organization will see a profit making opportunity to provide credible comparative information about various treatment options.
Democrats want a more federally directed approach, which implies tax money footing the bill to set up an organization that has a mandate to analyze different treatments for the same condition. They want to create a panel of medical and policy experts to help lead and direct research initiatives.
The second debate is over the implications of discovering that generally drug A is more effective than Drug B or surgery. Will we put something into place that is rigid, forcing a doctor, in all scenarios, to choose A over B or face consequences, or flexible, serving simply as a well researched database that a doctor can consult in his or her decision making process.
Finally, the debate is over whether comparative effectiveness should compare outcomes solely, or factor in costs as well. Choice A is 20% more effective or likely to cure the patient, but choice B is 1/10th the cost. Does this mean the doctor should choose choice A or choice B?
I believe comparative effectiveness is what the former sports caster Sarah Palin was referring to when she used the fear mongering “death panels” for “grandma” rhetoric.
What confuses me about this argument is that in our current system insurance companies and medicare / medicaid generally dictate to doctors what they can and cannot do to treat a patient with a specific condition and how they will be reimbursed. We already have a flawed system that in some cases doesn’t allow the doctor on the front lines to take into account the specifics of a patient case to make the best decision on behalf of that patient.
So I don’t understand why the private insurers allowing some treatments and not others are any less “death panels” than a panel of experts earnestly trying to research different treatments and their relative effectiveness.
I also don’t know why comparative effectiveness panels are being painted as an all or nothing proposition. It seems what Sarah Palin is arguing is that if we have panels that do research then doctors will be forced to comply with their recommendations regardless of specific circumstances that might lead a doctor to make other choices. Couldn’t we have comparative effectiveness results that are there for reference, or that should be followed 50% of the time, with the doctor allowed to choose 50% of the time to treat a patient differently than the recommended approach? My point is that there is a lot of grey area between the picture Sarah Palin paints and the other extreme of comparative effectiveness serving solely as a reference.
In watching Meet the Press this morning, it seems, as always, like neither side is really listening to what the other is saying, selectively choosing what they want to hear so they can make their argument for or against comparitive effectiveness.
Interestingly, here’s an interview I did in 2007 with the Dr. William Rich, Medical Director for Health Policy, American Academy of Opthalmology, around the first government funded test of two treatments for
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