WASHINGTON — WASHINGTON - Medical researchers and politicians are tiptoeing into an area of health care that makes some Americans uncomfortable, even angry, and it has nothing to do with such hot-button issues as cloning and stem-cell research. This time, the idea is to press doctors and patients to use particular drugs and treatments in order to save money.
On the surface, it seems simple enough: Billions of dollars could be saved if everyone adopted the regimens that research showed were best and most cost-effective - which, experts say, happens far less often than most patients think.
The problem is that any move to push doctors and patients to make a particular choice collides with the American belief that medical decisions are nobody's business but the patient's and the doctor's. Least of all, the government's.
Also, because the research is based on statistical analyses and there are trade-offs in almost all medical choices, there's sometimes room to disagree about what constitutes the "best practice."
Yet scientists, medical-policy specialists and leading politicians are starting to embrace the idea of using cost-effectiveness research to drive individual medical decisions. They call it "comparative effectiveness" research, sidestepping a direct reference to costs.
Democratic presidential candidate Barack Obama of Illinois is calling for substantial investment in the idea. And Republican candidate John McCain is interested.
In Congress, Democratic Sens. Max Baucus of Montana and Kent Conrad of North Dakota are expected to introduce legislation soon that would create a government institute to conduct such research. Baucus leads the Finance Committee, which oversees Medicare and Medicaid, and Conrad is budget chairman.
Americans are expected to spend $2.4 trillion on health care in 2008. Within a decade, the figure is expected to surpass $4 trillion a year and account for 20 percent of the gross domestic product, the most commonly used measure of total U.S. economic output.
"Learning how to spend smarter is one of the three or four critical things that needs to happen in our health-care system," says Gail Wilensky, a leading Republican health policy expert and former Medicare administrator. "Not only is it something the Democrats have been interested in, but a number of Republicans think this is the kind of information that is consistent with market strategies that help doctors and patients make better decisions."
