Friday, April 10, 2009

Rhoads on "Comparative Effectiveness Research"

Jared Rhoads, director of the Lucidicus Project, has written another excellent OpEd, this time on the dangers of "comparative effectiveness research". This is an important part of President Obama's intended health care "reform", and is yet another method by which the government will control how physicians practice medicine.

Here is his piece in its entirety, reposted with his permission:
It's not about "effectiveness"
By Jared M. Rhoads

Last month, President Obama signed into law the American Recovery and Reinvestment Act, a piece of legislation intended to stimulate the economy by "laying the groundwork" for recovery with smart investments in infrastructure, jobs, and research. Among the many provisions for healthcare, the act sets aside $1.1 billion for government research to determine which treatments, drugs, and technologies are the most effective in preventing, diagnosing, and treating various conditions and disorders.[1]

From a strictly medical perspective, this type of research is intriguing because the precise risks and benefits of many treatment options are unclear, and often it is not understood why some therapies work for some patients and not for others. But why is this any business of the federal government?

Supporters of the research defend the spending on the grounds that it will help to make programs such as Medicare less wasteful. Comparative effectiveness research, they say, will ensure "responsible stewardship" of the public's funds by allowing the government to pay only for what works.[2] For example, if researchers find that some cheaper alternative works just as well across a population as a more expensive treatment, then the government could change the Medicare reimbursement structure to provide an incentive for the former and a disincentive (or outright penalty) for the latter.

Interestingly, such uses of the research findings are explicitly prohibited in the text of the Act. Section 804 stipulates that the law shall not be construed to permit the Federal Coordinating Council to mandate coverage, reimbursement, or other policies for any public or private payer based on the findings of researchers.

But that will not stop the government. In due time, Congress will strike, amend, ignore, or "provide clarification" such that it will be possible for the government to use these findings to substitute the cheapest possible care for patients, Canadian-style. Guaranteed. After all, if the findings cannot be used to inform policy making, then why bother doing the research at all?

Investing taxpayer money in the name of delivering care more efficiently does not change the fact that there is no rational justification for government involvement in healthcare in the first place. If a man is robbed at gunpoint, does it make any difference how carefully and "effectively" the thief spends the loot?

The purpose of government is to protect rights, not play universal problem-solver for all manners of health and welfare needs. To even discuss the alleged merits of such research is to evade the source of the funds (confiscatory taxes) and lend credibility to those who seek to expand the reach of government into medicine.

Comparative effectiveness research sets the stage for an unprecedented increase in the government's power to control what treatments providers can prescribe and to whom. We already have a mechanism by which to determine and reward best practices: the free market. But unless the market is allowed to operate unhampered and unfettered, we will never escape the cycle of programs breeding programs.


1 H.R. 679; 111th Congress (2009): American Recovery and Reinvestment Act of 2009

2 Paduda, J. "The horrors of effectiveness research" Managed Care Matters. In his article, Paduda writes: "I'm completely disgusted with the hypocrisy of the libertarian right; those who have screamed for years about the ineffectiveness of government, ranting nonstop about how government can't do anything right, yet are now screaming even louder as government attempts to make sure they are responsible stewards of the public's funds."