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Stop the lies about comparative effectiveness

Give the doctors honest data, give them a process to argue successfully against the data in specific cases, add some transparency, and it doesn't matter who pays, care gets better and costs go down.

Within the health care industry, comparative effectiveness is an established goal.

It's so established that even AdvaMed, the medical device lobby, is speaking up for it, even while warning of its possible consequences.

There is a difference, however, between business arguments and political arguments. Businesses that tell lies can go under and their leaders risk jail. Politicians are under no such restriction.

Former Southern Baptist head Richard Land (right) is, in this context, a politician. He is allowed to lie.

Take this whopper:

Make no mistake about it – this bill mandates over a billion dollars to lay the initial building blocks in the foundation of a national health-care superstructure that will ration medical care to the sick and the elderly, with government bureaucrats (not doctors) making the medical decisions.

There are two lies being told here, and I've seen them spoken or implied in every political argument concerning comparative effectiveness research:

  1. This is all a secret plan for nationalizing health care.
  2. The private system does not ration care based on costs and data will make it possible.

The first is pure misdirection. The Administration is not proposing doing away with private health insurance. Making the claim is like the magician waving one hand while pulling out the bunny with the other.

It is possible companies could drop plans and move employees toward buying from a national plan, perhaps with a subsidy. But subsidizing the purchase of health insurance was a Republican idea during the last campaign.

The second claim, that we're not now rationing, is a flat-out lie, as anyone who has ever tried to appeal an insurer's refusal to cover a procedure knows.

It's true these refusals are not always based on good science. Some who fight hard can overturn the decisions. But that is not an argument against getting the data. It's an argument for it.

The government's point man for this approach is OMB director Peter Orszag, as Jeff Goldsmith explained recently at the Health Affairs blog.

While being interviewed by TV reporters on the budget, Orszag himself pointed to what this blog wrote about yesterday, disparities in health care costs that cannot be readily explained.

Why does it cost $3,000 more per year to care for a Medicare patient in Panama City, Florida than in Albany, Georgia, just an hour away? Why are costs in Wausau, Wisconsin $2,000 per patient higher per year than in the areas around it?

It will take a lot of data to answer those questions. Collecting the data, doing the analysis, is what comparative effectiveness is all about. It's what the insurance industry has been trying to do for years.

Give the doctors honest data, give them a process to argue successfully against the data in specific cases, add some transparency, and it doesn't matter who pays, care gets better and costs go down.

Costs have to come down because over half the American people skipped needed care in the last year. They were priced out of the market.

What we have today is rationing. Data can at the very least reduce it by giving doctors cost-effective alternatives to just saying no.

Anyone who tries to argue otherwise is selling something.