More Health Care Heresy from Newt

by Jonathan Cohn | December 13, 2011

Newt Gingrich’s past endorsement of an individual mandate has drawn fire from conservatives. But that's not his only health care heresy.

In 2008, Gingrich made the case for another idea that became part of Obamacare and, in due time, the focus of right-wing attacks. Worse still, at least from the standpoint of conservatives, he did so by writing an op-ed for The New York Times.

Oh, and did I mention he had some help? Gingrich had a co-author: John Kerry, the Democratic senator and former presidential nominee.

The title of the article was “How to Take American Health Care from Worst to First” and it was actually a collaboration by Gingrich, Kerry, and Billy Beane. If you follow baseball or read (or saw) Moneyball then you are familiar with Beane. He’s the revered general manager of the Oakland Atheletics who helped pioneer the use of "sabermetrics."

Over time, Beane was able to get better players for the A's, at a cost his financially limited team could afford, by using more finely tuned statistics. And in the Times op-ed, the writers suggested that doctors and hospitals could apply a similar approach to medical care, using statistics to provide treatments that did more for less money. The only problem, Gingrich and his collaborators pointed out, was the lack of good data:

Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition. 

A few innovative health care organizations have been able to create, and apply, their own data. Among them is the Intermountain Health Care in Utah. Intermountain has won acclaim for producing high-quality care at costs that are about one-third less than the national average.

Gingrich, Kerry, and Beane cited Intermountain as proof that data could boost efficiency, but they also acknowledged that ultimately the private sector couldn't solve this problem on its own. More action was necessary, they said, and that action had to come from government:

Working closely with doctors, the federal government and the private sector should create a new institute for evidence-based medicine. This institute would conduct new studies and systematically review the existing medical literature to help inform our nation’s over-stretched medical providers.

Does that sound familiar? It should, because the Affordable Care Act created just such an institute. Its formal name is the Patient Centered Outcomes Research Institute, or PCORI. Here’s the official description, from its web page:

The Patient-Centered Outcomes Research Institute (PCORI) is an independent organization created to help people make informed health care decisions and improve health care delivery. PCORI will commission research that is guided by patients, caregivers and the broader health care community and will produce high integrity, evidence-based information. 

David Cutler, the Harvard economist and former health care adviser to Obama, says the similarity is hardly coincidental. “Like most sensible people, “ Cutler says, “Newt Gingrich realized that having the government produce information on what works and what does not is a great way to lower the cost and improve the quality of medical care.”

Right -- except that “sensible” turns out to be a subjective term. Ever since Obama started talking up the concept of researching the effectiveness of treatments, back in 2009, prominent Republicans and their allies have been attacking it -- in some cases, suggesting it is a first step towards the rationing of health care and denial of care to the sick and elderly.

The Wall Street Journal editorial page, for example, has said that “political comparative effectiveness isn’t about informing choices. It’s really about taking away options.” That was nuanced compared to what Mike Huckabee wrote in his book: He said that the initial funding for comparative effectiveness studies, which was “tucked away into” the Recovery Act, had “planted the seeds from which the poisonous tree of death panels will grow.” 

I e-mailed the Gingrich campaign earlier today, to see if he stands by the op-ed. I haven't heard back. (I'll update this item if/when I do.) But I wouldn't be shocked if Gingrich says he's changed his mind, because he's done that before. As my colleague Alec MacGillis first reported in 2009, Gingrich was an advocate for better end-of-life planning – until reimbursement for such planning became part of Obamacare. At that point, Gingrich joined the "death panel" chorus. 

Then again, Gingrich could stand by the op-ed, which happened to anticipate some of the criticisms and make the commonsense case that more information is better: 

Evidence-based health care would not strip doctors of their decision-making authority nor replace their expertise. Instead, data and evidence should complement a lifetime of experience, so that doctors can deliver the best quality care at the lowest possible cost.

Of course, the same argument would apply to PCORI, the institute many conservatives are bent on crippling or even destroying.

That's the problem for Gingrich when it comes to improving the delivery of health care. He isn’t crazy. But plenty of influential conservatives are.

Source URL: http://www.newrepublic.com//blog/jonathan-cohn/98507/newt-gingrich-health-care-comparative-effectiveness-rationing