It’s no secret that health care is expensive, and it’s not a service that one can just forgo. In fact, half of all bankruptcies can be at least partially attributed to unwieldy medical bills. On the macro level, premiums have increased 120 percent in the past 10 years, and health care costs take up 17 percent of our national wealth. As a country, we spend a lot on health care, but the real tragedy is that a whole lot of that cost is being wasted on procedures and drugs that aren’t actually helping patients. This could include prescribing the wrong drug or doing an invasive procedure where pills would have been safer and just as effective.
The health care costs accruing to your grandparents or parents or — hopefully not — you may be thousands of dollars more expensive than necessary, if there’s another, cheaper treatment that’s equally effective. The Washington Postcites estimates that 20 to 30 percent of our health care expenditures are going toward “useless, potentially harmful care.” But a small appropriation tucked into the recent stimulus bill is intended as antidote to this superfluous spending.
While much of the $756 billion stimulus bill, which was passed Feb. 17, was devoted to spending and tax cuts that are supposed to benefit the economy immediately, some $1.1 billion of the plan was set aside for “comparative effectiveness research.” If that sounds like dry bureaucratese, that’s because it describes a boring, bureaucratic function. But the implications of this plan are far from tedious, and will affect anyone who ever makes a visit to the doctor.
Comparative Effectiveness Research is a provision for 15 civil servants who will compare the effectiveness and cost of medical treatments and drugs, and make their recommendations and research public. They will also make recommendations to governmental health care agencies to do certain kinds of research and help coordination efforts.
A database, available to doctors and patients, that provides them with information on the cost and effectiveness of various treatments for any given ailment seems like an obvious resource that someone would have come up with already. But it doesn’t exist, yet.
Instead, drug companies run clinical trials for their drugs, then private and government labs do studies on the effectiveness of individual treatments. But these studies don’t take into account how much treatments cost and rarely do they compare the effectiveness of one course of treatment to another. Basically, your doctor may not know whether the treatment she’s prescribing you is the most cost effective, or whether other treatments exist that are equally effective but are a lighter financial burden.
Heart-attack treatments serve as a useful example of possible health care inefficiency that comes from not knowing enough about each treatment. There are two ways to treat heart attacks: prescription drugs and stents, small tubes placed in the arteries to help increase blood flow. A study done by researchers at Duke University, published by the New England Journal of Medicine, found that, although there was barely any difference in outcome, the stents cost on average $7,000 more.
The study authors calculated that $700 million could be saved if the heart attack patients who didn’t need stents were instead prescribed pills. With government-funded comparative effectiveness research, there would be more of these types of studies and doctors would have a better idea of what treatments to prescribe.
“Having an entity definitively compare these newer, and often more expensive, options with established treatment regimens will be particularly useful in everyday practice,” wrote Kevin Pho, a New Hampshire internist and author of a popular health care blog. Without a single, centralized organization to arrange and carry out this comparative research, doctors have nowhere to go to compare treatment options.
There are concerns that this type of research could lead to, in the words of conservative health care analyst Betsy McCaughey, an open door for government “monitor[ing of] treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.” Moreover, it seems reasonable to leave the decision-making up to the doctor who’s familiar with the case, and certainly some people don’t want a government definition of “effectiveness” or “efficiency” to determine something as important as the medical treatment they receive.
Yet the government, through Medicare, already refuses to fund certain treatments that it deems to be ineffective or not worth their cost. Comparative Effectiveness Research would give the government more information with which to make those decisions. When 100,000 patients have tubes in their arteries that they don’t need, and 30 percent of health care dollars are spent on useless procedures and drugs, it’s hard to argue that doctors are already equipped to make the best decisions possible. More research done on how effective various treatments are could then improve those statistics.
Despite the aggregate inefficiency of health care costs, the pharmaceutical companies that make the newfangled drugs and devices benefit, making their efforts to get the appropriation for C.E.R. stripped from the stimulus bill unsurprising. So next time you discuss a treatment with your doctor, especially a serious, expensive option like, say, back surgery, ask her if that’s the best treatment for the money you’re spending. And if she can’t tell you, then maybe you’ll see why this little appropriation is so important.