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WASHINGTON — Herb Sanderson, AARP advocate and spokesman in Arkansas, remembers getting the calls shortly before Congress passed the $787 billion economic stimulus measure last month.
Out of that gargantuan sum, a dust-up had started over a relatively tiny, $1.1 billion slice of the bill. Some concerned AARP members in Arkansas wanted to know if it were true that members of Congress were about to lay the groundwork for the rationing of health care in America, especially to the elderly.
Such talk was making its way through doctors' offices around the state and on right-wing radio because of allegations made by Betsy McCaughey, a patient advocate and former lieutenant governor of New York. Her charges appeared in a commentary carried by Bloomberg.com and were avidly devoured by hosts of right-wing radio shows and others who claim President Obama is determined to lead the country toward socialism.
Many didn't realize it was a commentary piece, not a news article, Sanderson said in explaining the concern he was hearing.
But to see just how touchy the issue remains, one needs to look no farther than the AARP's own website, aarp.org. It's still brimming with article reprints, statements from prominent congressional Democrats and stories done in question-and-answer formats to calm those who remain upset about a section of the bill directing government agencies to engage in “comparative effectiveness research,” a hotly debated medical term of art.
McCaughey charges the AARP, and those who voted for the bill, which includes the five Democratic members of Congress from Arkansas, sold out the elderly. The lawmakers deny it.
At its simplest, the term “comparative effectiveness research” refers to comparing the effectiveness of certain types of treatments for the same disease or ailment and in some cases their costs as well.
One formal definition, offered by the Congressional Budget Office in a December 2007 report, is “a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and the benefits of those options.”
Although the concept has been part of the lexicon of medicine for decades, it makes people like McCaughey, chairman of the New York-based Committee to Reduce Infectious Deaths, nervous.
Some people may remember McCaughey as the author of a controversial article in the The New Republic that helped defeat the 1994 health care reform efforts of Hillary Rodham Clinton, then first lady, now secretary of state.
In her Bloomberg.com piece, McCaughey, referring to the House version of the bill, portrayed it as an effort to set up a health care system in which a new bureaucracy, the Federal Coordinating Council for Comparative Effectiveness Research, would be established as part of a decision-making web that utilized new health information technologies, ones that make up-to-date medical histories readily available to doctors and hospitals. Using comparative effectiveness research, she charged, this new office could end up telling doctors how to treat their patients. She said the idea mirrors what former Sen. Tom Daschle calls for in a new book about controlling health care costs. Daschle, who was on his way to becoming the next head of the Department of Health and Human Services before being sidelined by questions over back taxes, wrote that doctors would have to forgo being “solo practitioners.”
McCaughey believes federal bureaucrats would be able to call on comparative effectiveness research in denying some types of treatment to Medicare and Medicaid recipients. And then they could withhold payments from doctors who did not follow their guidelines.
In the version of the bill Obama signed, House-Senate negotiators changed some of the language, making clear that comparative effectiveness research would only be used for determining “clinical approaches” to treating patients without consideration of cost. But the idea of a Federal Coordinating Council for Comparative Research was retained.
McCaughey maintains the spirit of the House language allowing consideration of both costs and effectiveness of treatment, remains in the bill if it's read closely.
It's clear the AARP remains on the defensive. It responded to many of the criticisms and concerns of its members in a question-and-answer post on its website. One example:
Question: Why didn't Congress debate the bill openly and in the public eye?
Answer: “Both comparative effectiveness research and health IT [information technology] have been around for years, if not decades, and they were in the economic recovery package from the beginning. They've been debated in congressional committee hearings and on the floors of Congress. ... All the legislation does is to provide more funding for research that's been going on for years.''
The organization also emphasized: “No part of this bill will prevent your doctor from prescribing the treatments that are most appropriate for you. In fact, the legislation makes clear that this research will not mandate any coverage policies for any private or public payer.”
Similarly, Uwe E. Reinhardt, an economist at Princeton University, said in the New York Times that he didn't see the same dire consequences from the bill as McCaughey. Conservatives at the American Enterprise Insitute and Heritage Foundation contend that government-run health systems in Europe demonstrate how comparative effectiveness research could be used to deny coverage.
Arkansas lawmakers tend to think McCaughey and her allies are making mountains out of molehills.
Sen. Mark Pryor dismissed questions about McCaughey's article. Pryor spokesman Michael Teague issued a terse e-mail saying the senator would not spend time responding to such “nonsensical” and “debunked” charges.
Other Democratic members from Arkansas also defended their vote for the stimulus bill. Rep. John Boozman, the delegation's only Republican, voted against it.
“It is absolutely untrue that the bill will limit any person's access to care,” wrote Sen. Blanche Lincoln's spokesman, Katie Laning Niebaum.
“The fact is, the bill funds unbiased research on what works in medicine and what doesn't. The research will go to doctors and patients so they can make better treatment decisions.”
Rep. Vic Snyder said through a spokesman: “The health care provisions in the Economic Recovery bill are an excellent step towards more efficiency in health care for all of us.”