The Mighty Wurlitzer makes its first sound check

NPR has an interesting story on the curious case of "comparative clinical effectiveness research" which basically monitors the effectiveness of medicines and medical devices. The point is to improve care by figuring out what works and what doesn't. And this is regardless of cost, though it does, theoretically, lower costs by figuring out what procedures are a waste.

This would generally be considered a good thing. Indeed it had bipartisan enthusiasm, not just support, including the support of the John McCain health care adviser.

Seems, though, that Republicans now smell the sulfuric hint of universal health care in this small whiff of health care sanity. So the jukebox starts playing those familiar songs: an op-ed in the WSJ, Limbaugh (himself a self-medicating expert on drug efficacy) picks it up, and soon House Republicans begin their inevitable braying.

Of course, it would have been nice if NPR had been a little more direct in calling "bullshit" on this, but it is a potentially useful preview of the battle to come over health care.

Nevertheless, because this is nothing if not a public service blog, we turn to Steven Pearlstein (via Klein) for the aforementioned calling of "bullshit."

There's nothing particularly new about comparative effectiveness research -- the National Institutes of Health, along with the Agency for Healthcare Research and Quality, have been doing it for years, with a budget last year of about $335 million. But with the strong backing of the Obama administration, House Democrats are anxious to ramp up the effort, which nearly all experts agree is a necessary first step to reforming a broken health-care system.

To some, however, the wording in last month's House report was anything but innocuous. To them, it was a warning shot across the bow, the camel's nose under the tent of a government-run health system, the dangerous first step on the slippery slope toward European-style health-care rationing.

" 'Stimulus' bill may change health care forever," blared the headline in the Washington Times over a commentary written by Amy Menefee, communications director for the Galen Institute, a nonprofit think tank that aims to bring free-market ideas to the health-care debate.

"Ruin Your Health With the Obama Stimulus Plan," warned Betsy McCaughey, former lieutenant governor of New York and adjunct senior fellow at the conservative Hudson Institute, in a commentary distributed by Bloomberg News several days later.

No sooner had the McCaughey commentary hit the tape then -- what a coincidence! -- radio bloviator Rush Limbaugh was quoting it on his syndicated show, warning that under the world envisioned by the Obama stimulus bill, old people would be denied all costly medical treatments under a new "duty to die" regime meant to save taxpayer money. The McCaughey commentary also got a prominent mention by uber-blogger Matt Drudge.

The next day, the Wall Street Journal's senior economics writer, Stephen Moore, was on Fox News warning that the stimulus bill would put the government in control of what medical treatments you and your family would be allowed to receive. That set the stage for Megyn Kelly's interview with Sen. Arlen Specter, who was virtually browbeat by the anchor until he promised that "we are not going to let the federal government monitor what doctors do."

The Journal's editorial page picked up the campaign the next day, drawing the line of causation from electronic health records -- another beneficiary of the stimulus bill -- to comparative health records to government price controls and then a government-run "health tech monopoly."

This right-wing brushfire didn't start on its own, of course. It was a work of political arson by the country's drugmakers and medical device makers, which have the most to lose if there is solid research showing that some of their most expensive and high-margin products aren't really better than the low-priced spread. The flames were also fanned by "disease groups" like Easter Seals and the American Cancer Society, which fear that any attempt to determine what works best will inevitably lead to a one-size-fits-all approach to treating people with serious chronic conditions.

It's not that these various groups have no reason for concern. If comparative effectiveness research is done badly, or if the results are used simply as an excuse to deny insurance coverage for all expensive treatments, then there would be plenty of reason to get out the pitchforks and storm Capitol Hill. And there are surely examples from Britain and other countries of people being denied access to the latest drugs and procedures, including some that are significantly more effective than other treatments.

What the critics don't have, however, is any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients. There is no reason to believe that once this clinical research is completed, it cannot be used in a disciplined, scientific way by physicians, economists and medical ethicists to determine whether there are drugs, tests, surgical procedures or devices that simply don't deliver enough benefit to justify their cost. And there is no reason we cannot set up reasonable procedures, overseen by independent health professionals, to protect patients who can demonstrate a special need for a treatment that is not normally cost-effective.

Maybe it's not 1993, but I don't think we should be too complacent about that.