“A Daily Dose of Truth” (#6): The “R” Word (rationing) in Health Care Reform

~by Rev. Linda Hanna Walling, Faithful Reform in Health Care

Daily DoseTruth is witness to the whole.  One short sound-bite taken out of context — even if it’s a fact — does not necessarily represent the whole truth. We denounce the use of such sound-bites (from any party!) when they are intended to pervert truth for electoral gain. In the end, we acknowledge that a manipulation of facts to frighten and confuse vulnerable populations is just plain immoral.

Efforts to help us make informed decisions about our health care are supported by the comparative effectiveness research (CER) that is conducted by the National Institutes of Health and the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), among others.

The AHRQ’s website states that “comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.”

While CER has been a long-established but under-funded practice in the U.S., such research was propelled into national discourse when it received $1.1 billion in stimulus funds and the Federal Coordinating Council for CER was established. Now associated with the subsequent effort to reform health care, CER has become one of the targets of those who oppose reform – even though the results of the research will not be used to impose mandates on the delivery of health care.

For opponents to reform, this attempt to practice better stewardship in the distribution and use of our abundant health care resources has become synonymous with rationing.  But, truth be told, which is what this series is all about, is that rationing already happens in U.S. health care. 

We already ration health care when:

  • We exclude the nearly 50 million people who are uninsured from the system, leaving them without access to needed care in a timely manner.
  • Insurers can deny coverage to people with pre-existing conditions, or deny payment for services, or cap annual or lifetime payments for claims.
  • Some communities have access to an abundance of resources that are under-utilized (such as MRI machines) and other communities have none at all.
  • Some employers offer health care benefits, and some do not.

Very simply, CER represents a commitment to REDUCE rationing because research will inform better stewardship in the use and distribution of our abundant health care resources. The commitment for greater funding for comparative effective research is intended to move us closer to a health system that includes and works better for all of us. 

When coupled with other provisions of reform, CER will help us achieve our vision of a society in which all of us are afforded health, wholeness, and human dignity — and will lead to successfully designing a system in which our health care resources are shared equitably.

Note: The latest flurry of emails about this issue seems to have emerged as a result of a speech by an orthopedist who supports a particular candidate in a Michigan electoral battle.  He specializes in sports medicine, not health policy.

For more information:

U.S. Department of Health and Human Services, Agency of Healthcare Research and Quality – What Is Comparative Effectiveness Research?

Kaiser Family Foundation – What is Comparative Effectiveness Research?

PolitiFact – Analysis of claims made about comparative effectiveness research


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