The Citizens’ Health Care Working Group’s report is laced with the term “evidence-based”. This is hardly a surprise, as evidence-based medicine is currently all the rage among many health care policy analysts. (For more on evidence-based medicine, go here). For example, regarding the commission that will set core benefits (see post 1 in this series), the report states:

Within economic constraints and guided by evidence-based science and expert consensus regarding the medical effectiveness of treatments, the group will define the core benefits and services…

I suspect that Working Group (and health care policy analysts generally) is putting a bit too much stock in science and evidence. There seems to be an underlying but seldom stated belief that science and evidence can always provide a definitive answer. But science is a process of discovery that is marked with uncertainty. What is accepted practice today can be gone tomorrow because researchers have come up with better evidence or found a new way of looking at old problems. Sometimes the evidence doesn’t give a clear direction at all. For example, I’m currently working a Medicare study, and I’m looking at research regarding whether greater Medicare spending improves health outcomes. A lot of research suggests that it doesn’t, that areas that spend more achieve no better health outcomes than areas that spend less. However, some studies suggest that more spending does achieve better outcomes. Which is right? It’s hard to say.

In short, science and evidence often provide good guidelines, but they are not always definitive.

Yet the report suggests that evidence-based approach can yield definitive answers, calling for “a fair, evidence-based system to determine benefits”:

By way of illustration, if there are two equally effective ways to treat a particular medical condition, but one costs twice as much as the other, the less expensive treatment would have a higher efficiency rating. Health services and treatments that are deemed essential and cost-effective could be offered with little or no cost-sharing. Certain kinds of preventive care, such as childhood vaccinations, would be prime examples. Treatments that have not been proven to be medically effective would not be covered at all, to discourage their use. People who choose to obtain treatments or services proven to be not as cost effective as covered alternatives would pay more of the costs for that care.

If you read that carefully, you’ll notice that the Working Group is advocating a One-Size-Fits-All approach. If the evidence shows that two treatments are equally effective, the one that costs less will get better coverage. That begs the question, effective for whom? No two people are alike, and the treatment that costs less may not be as effective for some people.

By imposing a regime of evidence-based standards on the practice of medicine, the Working Group substitutes government regulations for the judgment of the physician and patient. Again, someone needs to read his Hayek.