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Hefty Health Spending in Stimulus Bill

Law Signed by President Obama Includes Funds for Medicare, Research, and Insurance

Comparative Effectiveness

Many policy experts are calling for more studies pitting different drugs, treatments, or care regimens directly against each other. The hope is that the studies will tell policy makers, doctors, and insurance companies which treatments actually work best and which are the most cost-effective.

Both parties have called for the research, and the bill devotes $1.1 billion to comparative-effectiveness studies at NIH and other agencies.

James Weinstein, MD, a comparative-effectiveness researcher at the Dartmouth Institute for Health Policy and Clinical Practice, says the health system is full of examples of more expensive treatments that may not necessarily be better. One example is thiazide diuretics, which research suggests are just as effective as more expensive calcium channel blockers at lowering blood pressure, preventing heart attacks, and avoiding hospitalizations.

"And if the drug was the same, shouldn't the nation think about using the drug that's just as good for a third the price?" he tells WebMD.

The inclusion of the money in the stimulus package angered some Republicans, who argued that the new law opens the door for government or private insurers to refuse payment for certain kinds of care based on the studies. That could lead to rationing of medical care if the government takes a bigger role in national health policy as part of reform efforts.

Billions of dollars could be at stake if one drug or treatment is found to be more cost-effective than another, Aaron says. He called the studies potential "political dynamite."

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