JONATHAN COHN OCTOBER 6, 2011
[Guest post by Darius Tahir]
It’s a minor irony that, when the Republican-dominated House Appropriations Committee proposed on September 29 to defund major parts of Obama’s recently-passed health care reform bill, the proposal went after those portions of the Affordable Care Act intended to actually reduce the deficit in the long-term—most notably, comparative effectiveness research into the cost and outcomes of various medical treatments. Why only minor? That’s because no one has an absolutely clear sense of how well this portion of the Affordable Care Act will end up working. To get an idea, however, I interviewed four experts about the possible cost savings from the research that Republicans are attempting to defund. The majority agreed that—if the Republican committee members’ goal is, in fact, to reduce the long-term deficit—they’re going about it in a rather counterproductive manner.
In 2007, Peter Orszag, then-director of the Congressional Budget Office, released a 35-page report summarizing the possible benefits of comparative effectiveness research—that is, creating some sort of entity to coordinate and publicize research about the efficacy of various drugs and treatments. Orszag’s report vacillated from optimism to sober minimalism. On the optimistic side, it noted that “some experts believe that less than half of all medical care is based on or supported by adequate evidence about its effectiveness,” which might suggest substantial savings down the line if we can just figure out what works and what doesn’t. On the more sober side, the report concluded that the net budgetary savings from a well-funded center (with costs starting at $600 million and eventually reaching $2.1 billion) would equal $1.3 billion over a decade. It also estimated that the research would reduce private health care spending by five times that number once knowledge of the research permeated the medical community and public at large, with the trend accelerating in the second decade.
When the CBO scored Obama’s final health care bill in 2010, however, it took a rather skeptical approach to the cost savings inherent in such research, projecting only modest savings and prompting some critics to deride the measures intended to curb costs as sorely insufficient. So how much of an effect would the GOP’s plan to cut comparative effectiveness research really have?
Most of the experts I interviewed ultimately agreed with the mixture of optimism and minimalism that characterized Orszag’s 2007 CBO report, arguing that the benefits were uncertain, but important to explore. “It’s important to try,” Stuart Guterman, of the Commonwealth Fund, told me, characterizing efforts to cut the program as “cutting off your nose to spite your face.” Professor Michael Chernew of Harvard Medical School said that the efforts to cut off research would deny the country of an important potential investment. Paul Van der Water, a senior fellow at the Center on Budget and Policy Priorities, argued that the CBO assumed very small savings, but ones that would likely accelerate over the long run. He added that there would be no savings if you never even tried.
Joe Antos of the American Enterprise Institute, on the other hand, had some skepticism for the overall project of comparative effectiveness research, raising questions about the program’s execution and the practice of guiding medical spending off of uncertain comparative effectiveness studies. His doubts dovetailed with those that have been aired by researcher and writer Jerome Groopman, who elaborated on the potential pitfalls in comparative effectiveness research in a piece in the New York Review of Books: “Over the past decade, federal ‘choice architects’—i.e., doctors and other experts acting for the government and making use of research on comparative effectiveness—have repeatedly identified ‘best practices,’ only to have them shown to be ineffective or even deleterious,” Groopman wrote. As evidence, Groopman noted how his own research into growth factors, seemingly an excellent aid for certain kinds of cancer patients, was later complicated and shown to contribute to a risk of strokes and heart attacks.
Failure, however, hardly seems a reason not to try, as Van der Water argued to me. The health care reform bill was designed to embrace a variety of methods to try to reduce spending, and the hope is that one of them will work. Otherwise, our government’s outlays on health care will become the real budget apocalypse that GOP House members are ostensibly trying to solve.
Darius Tahir is an intern at The New Republic.