The Right Prescription

Obamacare’s Sales Force

How did it escape the House Republicans' budget axe?

By 2.15.11

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House Republicans plan to cut $360 million in Obamacare funding in this year's budget. That's a good start, enough to slow implementation of the health care law but not stop it. But not good enough to stop the administration from spending $100 million to run an ad campaign and hire a sales team to push Obamacare to thousands of doctors. That's right. Obamacare will use a sales force (with cars and expense accounts) to convince doctors that government health guidelines are the way to go.

The home of this marketing machine is Agency for Healthcare Research and Quality (AHRQ). Its budget of nearly $1 billion a year (starting in 2014 it will be more) is scheduled to be cut by only $25 million this fiscal year. Perhaps Republicans don't know that AHRQ is the operating system for Obamacare as well as its campaign manager.

AHRQ is mentioned in the Obamacare law 12 times. The agency and its consultants -- most of them true Obamacare believers -- are responsible for determining what preventive services we get, what health care "quality" is, what should be cut from Medicare and what new technologies should be paid for.

AHRQ was behind the decision to restrict breast exams to women over 50. It supplied the "evidence" for annual end of life counseling for the same seniors it decided shouldn't get screened for depression or hip fractures. Meanwhile, it's funding radical organizations pushing for sex change operations and the autism-vaccine link.

And it has big plans for the rest of that money. The Obama administration is not content to control what doctors do. It wants to control what they know as well. Carolyn Clancy, AHRQ's director, talks about "embedding" directives, guidelines, and reminders into the electronic health records of every American. AHRQ is spending millions to insert clinical decision support tools for a variety of purposes. One of the most prominently mentioned: end of life care counseling.

But AHRQ is not just content to "embed" Obamacontent into the lives of every American. It is also spending $50 million to "build a marketing campaign around comparative effectiveness research. (CER)." CER is promoted as information about what are the most medically and cost-effective treatments, drugs, and medical devices. But what works and what doesn't can change almost daily and varies by individual. Simple blood tests and iPad-equipped sensors will be able to monitor many illnesses before they spread as well as individualize treatment of a disease.

AHRQ is not only spending hundreds of millions of dollars on studies claiming there's insufficient evidence to either use or pay for such technologies.

AHRQ is spending millions to insure that its information is found more quickly and more often on the Internet. Over 70 percent of all Americans use the Web to seek out medical information. AHRQ plans to crowd out other sources of advice by making sure Obamacontent is embedded in as many websites as possible and using search engine tools to drive doctors and patients to government friendly or supported sites.

AHRQ is spending $34 million for an ad campaign to get doctors to adopt comparative effectiveness research. Here too, the campaign is heavy on Web-based tools with the goal of trying to get AHRQ and its consultants positioned as "experts" on Twitter, Facebook, YouTube, and search engines. It is buying up ad space in medical journals, which AHRQ is also flooding with its studies claiming most new technologies are more effective than old ones.

In case doctors don't get the message "embedded" in health records and the Internet, AHRQ is hiring hundreds of Obamacare sales reps to convince physicians that Obamacare medicine is the way to go. AHRQ's Obamareps will be paid $20 million to sell doctors AHRQ prescriptions. For instance, AHRQ reps will tell doctors that that all diabetes, hypertension, and prostate cancer treatments are more or less the same, often using data a decade old.

Medical science is way ahead of AHRQ. Doctors are able to tailor treatments to the race, gender, age, family history of a patient, as well as the pathways many forms of cancer takes. Today new imaging technologies and genetic tests can help predict cancer risk. But AHRQ's sales reps will tell doctors there's no evidence they save lives.

Obamacare 's overlords want to monopolize medical decisions and medical information while marginalizing everything else. That goal is central to setting up the health exchanges and limiting choice. AHRQ's multi-million marketing campaign is critical to both. Unless Congress cuts it budget to nearly nothing, it will be impossible to repeal the law and replace it with something better.

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About the Author
Robert M. Goldberg is vice president of the Center for Medicine in the Public Interest and founder of Hands Off My H ealth, a grass roots health care empowerment network. His is new book, Tabloid Medicine: How the Internet is Being Used To Hijack Medical Science For Fear and Profit, was published last month by Kaplan.