What has been going on in the Senate Health, Education, Labor, and Pensions (HELP) Committee for the past three weeks? Unless you’ve been carefully watching the mark-up of the Kennedy health bill, you wouldn’t be aware that Senators have been battling over many of the 398 amendments proposed to the legislation. You also wouldn’t know that all attempts to protect patients from health care rationing were defeated.

Comparative effectiveness research (CER), which is research that compares the clinical and/or cost-effectiveness of two health care treatments for the same condition, has been a contentious topic since the giant stimulus bill provided government agencies with $1.1 billion to conduct it. The Kennedy bill includes an increased role for CER. How this language is to be interpreted is crucial.

There is nothing wrong, of course, with finding out what works and what doesn’t. The key issue is the consequence of the research findings for patient care, and whether those findings come with any regulatory or reimbursement strings attached to them. If CER can be used by the government to make payment, treatment, and coverage decisions, it could also be used as a rationing tool. Recently, the Senate Committee considered and rejected three amendments that were designed to prevent CER from becoming any such thing:

Sen. Pat Roberts (R-KS) amendment.
Sen. Tom Coburn (R-OK) amendment.
Sen. Mike Enzi (R-NV) amendment.

These three amendments would all have prevented the use of CER to ration or deny care or mandate coverage. All three were defeated on straight party-line votes. This is a serious development, and it has gotten little public attention in the general media.

As The Washington Post pointed out on June 8th, one of the key issues emerging in the national health care debate is whether or not there will be official limits on the kinds of care, medical treatments, or procedures that Americans can get. As The Post reporter noted, when asked a specific question on this issue, the President failed to respond.

The bad news is that a majority of Senators on the HELP Committee have responded in a way that most ordinary Americans would not expect. The truth is that with legislation authorizing the federal government to make key decisions on medical benefits and medical procedures, dictating the kinds of health benefits Americans will and will not have in the government-approved health insurance plans, federal officials would retain enormous power over the kind of care Americans would get.

The President has stated, repeatedly, that if you enjoy your relationship with your doctor, his proposals would not interfere with that relationship. However, if CER becomes a pretext for rationing, government policy would, in effect, destroy the doctor-patient relationship. It would not only devalue a physician’s professional judgment in a particular case, it would also amount to a violation of the traditional Hippocratic Oath. The traditional Oath, after all, holds that the doctor is a servant of the patient.

Americans should now realize that one of the most contentious issues of the national health care debate has already been joined. They should know that in this initial skirmish, Senate amendments to protect patients were lost with little fanfare. This isn’t the first and certainly won’t be the last time that such a battle will be joined. But it should be a wake- up call to taxpayers who think that the health care debate is merely a battle over the uninsured, over rules governing insurance markets, or over costs of these expensive House and Senate health care bills.

This post was co-authored by Julius Chen.