Congressional Budget for the United States Government for Fiscal Year 2010

Floor Speech

CONGRESSIONAL BUDGET FOR THE UNITED STATES GOVERNMENT FOR FISCAL YEAR 2010 -- (Senate - April 01, 2009)

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Mr. ROBERTS. Madam President, I rise today as a cosponsor and in support of the amendment offered by my friend from Arizona, Senator Kyl. I thank the Senator for introducing the amendment on behalf of health care providers not only in Arizona and Kansas but all across the country, and, as a result, the patients they serve.

I think we all know we have marching orders, if I can describe it that way, from the administration and from others to complete health care reform this year. But the President has been a little vague about what he envisions, stating that he will leave the details to the Congress, and the devil is, indeed, in those details. Senator Kyl has certainly pointed out one of the details that has to be fixed.

Let me be clear. I am not opposed to health care reform. I don't know who would be opposed to health care reform. But we must beware of what lurks under the banner of reform. I do support, as do many others, a system of affordable, accessible health care for all Americans. But I do not support a system that replaces the judgment of your doctor with that of a government agency, as described so ably by Senator Kyl. For this reason I share the concern of the Senator regarding the implementation of something called comparative effectiveness research. I wish more of my colleagues were in the Chamber to listen to this--listen to the description of what could happen in regards to something called comparative effectiveness research. The acronym for that, by the way, is CER.

This gets in the woods of health care reform. Comparative effectiveness research, or CER, is simply research that compares the effectiveness of two or more health care services or treatments. CER is not necessarily a bad thing. In fact, it has the potential to provide benefits to medical science and also, obviously, to patients. However, with CER policy--again, the devil is in the details. When discussing the details of comparative effectiveness research, we need to focus on another term, ``least costly alternative.'' This is where comparative effectiveness research has the potential to have a huge and negative impact on patient and doctor choice.

If comparative effectiveness research is used to deem two health care services or treatments to be interchangeable, then CMS, within the Department of Health and Human Services, will be able to invoke the least costly alternative to only reimburse the health care provider based on the cost of the cheapest treatment.

One need not look any further than the Congressional Budget Office's Budget Options, Volume I, Health Care, written under the direction of OMB Director Orszag, to see that the use of least costly alternative authority to restrict doctors' decisions and ration health care is clearly on the table.

Here is a good example. One of the CBO health care budget options discussed the savings that could be realized if CMS applied Medicare's least costly alternative policy to include something called viscosupplements. You use viscosupplements to treat a degenerative joint disease of the knees called osteoarthritis. A lot of Senators have knee problems--not only weak knees but sometimes knees that need a little help. So even though CBO recognizes that there may be justifiable reasons your doctor would choose to provide one viscosupplement over another to help your knees, this option would allow the Government to use least costly alternative authority to interfere with and restrict your doctors's decision. This is very dangerous territory.

Rather than having to depend on the rigorous clinical trials conducted by the Food and Drug Administration, the CMS could use the much lower bar of comparative effectiveness research to declare that the two treatments are interchangeable and thus can be subject to the least costly alternative policy.

This type of Government interference in the doctor-patient decisionmaking process ignores the very large and important differences that exist among people, among patients--I think that should be obvious--in favor of a one-size-fits-all health care solution that could and would lead to rationing of health care.

Let this be a warning to all patients, all doctors, all hospitals, all nurses, all ambulance providers, all pharmacists, all home health care providers--all of the people who provide health care throughout America, rural and urban. You are on notice that this policy combination--comparative effectiveness research and least costly alternative--may be the Holy Grail of cost containment at the expense of patient care. That is what Senator Kyl's amendment gets at.

My colleague's amendment prohibits the use of comparative effectiveness research to deny coverage of health care treatments under a Federal health program. It requires that comparative effectiveness research take into account the individuals and their treatment responses and their preferences, and it does protect doctor and patient sovereignty over health care decisions.

For these reasons I urge my colleagues to vote yes on the Kyl amendment.

I yield the floor.

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