Wednesday, February 11, 2009

Health Care Reform--The Stimulus PreGame

"Drug Makers Fight Stimulus Provision"
"Lobbying War Ensues Over Digital Data"

The first was a recent Wall Street Journal headline and the second headline comes from the Washington Post. Both refer to what were supposed to be two already agreed on health care reform ideas--comparative research about which treatments work best and the creation of a nationwide system of medical records.

The lesson here is that in health care nothing is easy, simple, or widely agreed to.

The stimulus bill will include about $20 billion for computerized medical records. The problem is privacy. Business interests want more ability to use health care data to market their products and identify people who can be treated more effectively--data mining for example. Privacy interests want tighter control of that data. Can a doctor or a hospital make money selling people's medical data? Could data ultimately be used to discriminate against people? Can drug companies pay doctors to send a letter to certain patients touting medications? Where does a system of information that could be used to alert patients to new treatments and used to track trends in health care effectiveness become at cross purposes with privacy?

This is not a new debate--a health information technology bill has been bottled up in the Congress for years over these kinds of issues.

Comparative research--which drugs or medical devices work the best--makes a lot of sense. That is especially true in the wake of decades of research that continues to point to wide overuse of technology as the primary cost driver in our health care system.

So you would think this one was a no-brainer. But wait. In the WSJ story, "The drug industry is mobilizing to gut a provision in the stimulus bill that would spend $1 billion on research comparing medical treatments, portraying it as the first step to government rationing." And you know, these guys never lose.

The rub for the drug and device industry is that this kind of research could actually be able to call balls and strikes--which treatments don't work well and therefore should have their use subordinated to those that work better. Already, in the Senate version the industry has been successful in getting language that added the word "clinical" which has the effect of having any studies avoid "bang for the buck" kinds of conclusions.

One billion dollars for comparative research but we aren't allowed to know which drug or device gives us the best return for our money?

And, these were supposed to be the easy parts of health care reform. I am again reminded of all the reports in recent months about how different the 2009 version of health care reform will be with the special interests really ready to cooperate.

Let me say it again, there is no consensus about just what any meaningful, or probably meaningless, health care reform bill will look like.

Can't wait for the main feature.


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