WASHINGTON — In an age when Americans compare hotel rooms, cars and even prospective mates with the click of a mouse, helping people identify the most cost-effective medical care seems like common sense.
But when President Obama included money in his economic stimulus plan to do just that, he set off one of the sharpest, and most unexpected, political fights of his young administration.
Though Obama prevailed -- securing $1.1 billion for "comparative effectiveness" -- the ferocity of the tussle over a relatively obscure proposal provided a warning for those seeking to reshape the nation's healthcare system.
Obama is to outline more of his healthcare overhaul plans when he addresses Congress today and unveils his first budget two days later. He said Monday that he also planned to hold a conference next week on healthcare reform.
The comparative-effectiveness issue was supposed to help lay the groundwork for the broader reform effort. But it became a lightning rod for conservative commentators who labeled it a step toward socialized medicine, a line of attack that has doomed every health overhaul effort since World War II.
Rush Limbaugh joined the fray. So did an Iowa advocacy group that targeted Capitol Hill with a fierce e-mail campaign. The conservative Washington Times suggested that what Obama wanted to do might lead to Nazi-style euthanasia, and the paper posted a photo of Adolf Hitler next to an editorial denouncing the bill.
Within hours, newly empowered liberals struck back. Using muscles honed fighting the Bush administration for eight years, bloggers and television commentators attacked critics of the legislation as uninformed and unprincipled.
"I am a little surprised," said Kaiser Family Foundation President Drew E. Altman, a leading reform advocate. "But there are institutional forces in Washington set up to fight these fights. It's what they do. . . . The tone may have changed with the new administration, but not the way the game is played."
Altman and others had hoped the healthcare overhaul campaign promised by Obama would begin more harmoniously.
Many healthcare authorities and policymakers have agreed for years that a better system for tracking how well drugs, medical devices and surgical procedures work could improve the care Americans receive and ultimately save billions of dollars.
Almost from the start, the initiative proved explosive, although the battle was at first fought largely out of public view.
Pharmaceutical companies and medical device makers, long wary of the implications of comparative effectiveness, pounced on a suggestion in a report accompanying the legislation that the research could help eliminate costly treatments.
"You have to be very careful," said W.J. "Billy" Tauzin, who heads the Pharmaceutical Research and Manufacturers of America, or PhRMA. "An arrogant staffer writing a report was about to dramatically change the direction of healthcare in America."
PhRMA and its allies succeeded. Senate Democrats clarified that the research would focus only on "clinical effectiveness."
As this was going on behind the scenes, a broader public war was brewing.
Republicans on Capitol Hill, working to discredit the stimulus package, began labeling the comparative-effectiveness research as a step toward "government-run healthcare."
The cause was picked up by conservative commentators, including Betsy McCaughey, who rose to prominence 15 years ago with a controversial -- and later discredited -- magazine article attacking the Clinton administration's healthcare proposal.
On Feb. 9, McCaughey published an op-ed commentary for Bloomberg warning that the legislation would allow Washington to "monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost-effective."
Within hours, Limbaugh was attacking.
By the next morning, Fox News touted the discovery of a "secret" in the legislation that could lead to "healthcare rationing for seniors."
In Des Moines, the American Future Fund, an advocacy group that bills itself as a conservative answer to the influential liberal MoveOn.org, was mobilizing its membership.
"The GOVERNMENT may deny Medicare treatments to our mothers, fathers and grandparents!" the group warned in an "action alert" urging members to e-mail members of Congress.
A spokesman for the group, which does not disclose its donors, said members sent thousands of e-mails to Capitol Hill.
Even some Republicans were stunned at the rhetoric, one Senate Republican aide said.
The campaign prompted a fierce response from liberals.
Media Matters, a website launched in 2004 to track "conservative misinformation" in the media, posted lengthy rebuttals to McCaughey, Limbaugh and Fox News. So did liberal bloggers at Washington Monthly and the Center for American Progress.
By the end of the week, Keith Olbermann was airing a lengthy segment on MSNBC targeting McCaughey.
That kind of response didn't happen 15 years ago, said Chris Jennings, one of the leading architects of the Clinton administration healthcare campaign.
"This time, there was a much more effective push-back," he said.
When Obama signed the stimulus bill last week, the White House claimed an early victory in its drive to overhaul the nation's healthcare system.
Tauzin of PhRMA said the controversy served a purpose.
"I hope it is a clear warning," he said. "There are a lot of beehives out there. You don't just go around punching them."--