This opinion piece ran in the Washington Times on Wednesday, March 25, 2009 in a special section on health care. To see the original story, click here.


By Kay Granger

The overwhelming reason our health care system isn’t working is that too many Americans don’t have access to quality care. Today, only those fortunate enough to be able to pay for care out-of-pocket have access to innovative, life-saving care.

Health care is expensive, and costs keep rising – year after year. Americans spend $2.4 trillion a year on health care. A recent report by the Business Roundtable found that in 2006, Americans spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country. When faced with a major medical emergency, many American families find themselves unable to pay the astronomical bills.

More than three out of four Americans questioned in a recent CNN/Opinion Research Corp. survey are dissatisfied with the cost of health care in the United States. We must address rising health care costs in any health reform effort.

In the recently enacted stimulus bill, President Obama and Congressional Democrats included $1.1 billion in funding for “comparative effectiveness” research; supporters claim it will lower health care costs by urging health care providers to use the least-expensive treatments.

Comparative effectiveness research evaluates the merits of various medical treatments with the hopes of arriving at the best and least costly treatment for a condition. It is important to remember the difference between clinical effectiveness – which treatments work best irrespective of cost – and cost effectiveness, where the most effective treatments could be deemed inappropriate because their costs outweigh the perceived benefits.

Historically, comparative effectiveness has resulted in higher health costs. For example, when looking at what treatments are best for cardiac patients who enter an emergency room, numerous studies found that primary angioplasty, an expensive procedure, was the most effective treatment. That finding drove up health costs for cardiac care and treatment.

The other problem with comparative effectiveness research is that historically rigorous original research by the National Institutes of Health (NIH) has had little impact on the practice of medicine. Two NIH studies stand out as examples – Catie and Allhat. Seventy million dollars was spent on the Catie study, and $130 million was spent on the Allhat study. Despite the millions invested in these two research studies, they had almost no impact on clinical care.

The new “Federal Coordinating Council for Comparative Effectiveness Research” won’t do much to help contain and lower health care costs. What it will do is serve as political cover for the Centers for Medicare and Medicaid Services (CMS) to make coverage decisions. Once a decision is made not to provide Medicare coverage for a service or treatment, private insurance companies typically follow suit.

Comparative effectiveness research will be used to ration care and thwart innovation and medical progress. It is a first step toward taking medical decisions out of the hands of doctors and patients and allowing government bureaucrats to decide what drugs, screening tests, and medical procedures will be covered by Medicare. It is a step toward a government-run health care system.

In countries with government-run health care systems, comparative effectiveness is often used as an excuse to deny patients life-saving medical care on the grounds of cost-effectiveness. The health care board of the United Kingdom has repeatedly denied breakthrough drugs to citizens suffering with breast cancer, Alzheimer’s disease, and even multiple sclerosis on the grounds of comparative effectiveness.

The United Kingdom’s National Institute for Clinical Excellence (NICE) is having an impact on health outcomes – and it is not a positive impact. Between 1990 and 2002, deaths from breast cancer declined 2.3 percent annually. Today, nearly 98 percent of women diagnosed with early stage breast cancer in the United States survive at least five years. In the United Kingdom, the five-year survival rate for breast cancer caught early is just 78 percent. The same is true of colorectal cancer. The five-year survival rate for colorectal cancer in the United States is 60 percent compared with 44 percent in the United Kingdom.

We need to find ways to lower health care costs in this country without rationing care. At the same time we need to increase the number of Americans with health insurance. In my home state of Texas, one in four individuals is uninsured, and more than half of those without insurance say it’s because they can’t afford it.

The solution to lowering the number of uninsured Americans is not a government run “single-payer” or “public health insurance option” that takes away individual choices, doctor control, and threatens the employer-sponsored health insurance market. No one should have to lose his or her current health insurance coverage or change doctors because Congressional Democrats and President Obama push through health reform too quickly.

As House and Senate Committees begin holding hearings on health reform and bills are being drafted, we need to be careful not to enact provisions like comparative effectiveness that may result in higher health care costs. For example, the non-partisan Congressional Budget Office (CBO) released an analysis of President Obama’s fiscal year 2010 budget last week. CBO found that the health care reform proposals in the President’s budget will cost $21 billion more than previously estimated by the Administration. The expected cost of the President’s health care plan could reach $1.5 trillion while only about $600 billion is set aside for health reform in the “reserve fund.” The President and Congressional Democrats will have to come up with a way to pay for the escalating costs of their health reform proposals – whether it be through more cuts to Medicare Advantage, tax increases, cuts to other existing health programs, or the fiscally irresponsible choice of increasing the federal deficit.

It is difficult to see how the President’s proposals will bring down the cost of health care. We need to find fiscally responsible ways to expand access to affordable health care, and in doing so we need to be sure we are giving individuals and doctors control over making decisions about health care – not the government.