One little-heralded part of President Obama’s health-care reform law proposes to change that, possibly transforming medical practice for the better — but also probably inciting renewed political warfare over health-care “rationing.”
The concept is simple enough. The government should have delved into this sort of research with such ambition many years ago, as health-care costs rose steadily above inflation. Yet there are challenges. Maybe a treatment affects women differently from men, or the young more than the old. The statisticians will have to tease out those and other confounding effects. Results will not always be clear.
Even when they are, people will have to be convinced. Many will resist giving up a test or a drug they have come to trust, even if it’s proven ineffective. Consider the backlash when government researchers recommended that younger women stop getting regular mammograms. Doctors who make their living from certain treatments will warn of dire consequences to their patients’ health. That’s why financial incentives also will have to be reformed.
PCORI will encounter its share of political dogfights. Republicans will invoke the specter of government-imposed rationing. Some have already tried to ax the panel. Democrats will balk at the committee’s research as heartless number crunching. Removing ineffective treatment from the health-care system will be far from painless.
But the alternative — throwing money into the cash-gobbling health-care industry with little measurement or accountability — should be much less tolerable. In fact, the Affordable Care Act’s comparative effectiveness provisions don’t go far enough; the law bars the government from examining the cost effectiveness of medical practices in the most straightforward way. That analysis should at least be available for the public to consider.