For the uninitiated, comparative effectiveness is essentially taking a set of different procedures that serve similar purposes, and seeing which works better. In the ideal world from my perspective, it would also do an offhanded cost analysis as well. For example, while procedure A may be more effective than procedure B by about 5%. However, if A costs about 15% more, we should probably consider a set of different things, either having greater cost sharing on the patient or not reimbursing for it.
Of course, the strong hand of the experts will likely never come down like that, because we have an unusual level of trust in our doctors, and tend to dislike the government (reactance!). The key then is disseminating the information as best we can, I guess. The report does say:
"Compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others."
One way though to bring in the strong hand of the government is through the Medicare Payment Advisory Committee, known as MedPAC. Obama himself has sort of discussed this matter. However, one critic of the public plan also criticized part of this proposal. Much of the argument is that it is an anti-democratic notion.
I would point out that the delegation of powers to Administrative Agencies too is highly undemocratic. I am sure that MedPAC does, and will have to do some sort of notice and comment period themselves. Indeed the Base Realignment and Closure Commission (BRAC) did require the same sort of thing. However, it created a statutory change through the legislature. One could imagine MedPAC drafting resolution through some precommital rules, and then if legislators wish to change matters, they could. However, such changes should seek to stick to budget neutrality, and it would require the House not to have the ability to waive the matter, and it could have the Senate apply its 60-vote rule.
The bigger concern about all of this, and especially tying things to CER, is the 1990s Agency for Healthcare Research and Quality fiasco. Back then, AHRQ suggested that certain back surgeries were unnecessary. It led essentially to Congress cutting CER, which AHRQ does a small amount of. One concern about any governmental group that does CER, and which MedPAC would rely on and work with would have to rely on Congressional Appropriations. I know this is a small matter, but it is a problem.
That said, I am hopeful about this move itself. And I am excited about the report.
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