by Shannon Brownlee Hi there. I'm a senior fellow at the New America Foundation, a non-partisan think tank in Washington, DC. Thanks to Ezra and the American Prospect for the blogging real estate -- and thank you, loyal Ezra fans, for reading our stuff. I hope we can fill his shoes! On August 1 Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Budget Committee Chair Kent Conrad (D-N.D.) introduced a bill (S 3408) to create a public-private comparative effectiveness institute, which would be financed through an all-payer assessment -- self-insured employers, insurance companies, and CMS (the Centers for Medicare and Medicaid Services) would all contribute. It would be a not-for-profit private entity, not a federal agency. The Health Care Comparative Effectiveness Research Institute would be overseen by a board of governors, who would decide on research priorities and hand out the money to the National Institutes of Health and the Agency for Healthcare Research and Quality, which would presumably then provide funds to qualified researchers. Aside from the clunky name -- I prefer "Agency for Comparative Effectiveness" or ACE (as in bandage, because our health care system is broken) -- there is going to be some ugly lobbying against this plan, just as there was against a similar provision in the SCHIP bill that President Bush vetoed last fall. I'll write more about the fight that's brewing later, but first, why do we need such an institute in the first place? Because about half of what doctors do, according to the Institute of Medicine, is based in theory, tradition, or what's profitable, not in any kind of valid evidence. Much of the care they deliver doesn't work, or causes more harm than good, and if we could get rid of the useless stuff in our system we'd improve the care patients get AND save money -- as much as $700 billion a year according to Congressional Budget Office Director Peter Orszag. Some doctors pooh-pooh the idea that their treatments ought to be backed up by good science, calling it "one-size-fits-all" and "cookbook" medicine. The New York Times ran a great piece on June 29 on the overuse of CT scans to look for heart disease, a use of the technology that is almost evidence-free. The Times quoted one doctor who thinks evidence is overrated: “It’s incumbent on the [medical] community to dispense with the need for evidence-based medicine . . . thousands of people are dying unnecessarily.” Gosh, and here I've been thinking that scientific evidence was the thing that separates modern medicine from blood letting and leeches.
