The painful side effects of Obama's healthcare reform

If that sounds cold, or like an interference with the traditional physician-patient relationship, in which doctors make decisions -- call them "subjective" decisions, if you like -- about the most appropriate care for their patients on an individual basis, that is the very point. Obama and those who support his healthcare reform proposals have embraced a concept called "comparative effectiveness research." The idea behind comparative effectiveness research is basically a good one: Use large-scale scientific studies to determine which medical procedures produce the best patient outcomes in the aggregate, and whether some expensive tests, drugs and surgeries might not be as effective in the aggregate as cheaper alternatives.

Such information -- sometimes called "evidence-based medicine" -- can be helpful to doctors in deciding what treatments would be best for their patients and maybe save them some money. But Obama and his healthcare supporters do not want to stop there. Their implicit proposal seems to want to turn comparative effectiveness research into the "rules" that Obama was talking about on ABC: one-size-fits-all procedures that physicians would have to follow at the risk of not being paid by the government. And the government would increasingly be the payer if Obama's proposed "public option" health insurance crowds out, as it inevitably will, private health insurers forced to compete with a tax-subsidized government entity. A pacemaker for your otherwise tough-as-nails 99-year-old mother? Forget it, Mom, you die.

That's what Obama means when he talks about "difficult decisions at end of life," as he did on ABC, or "reining in costs," as he did in his New York Times interview. Congress has already slipped $1.1 billion into the economic stimulus law it passed in February to set up a Federal Coordinating Council for Comparative Effectiveness Research. Under Obama's healthcare plan, physicians participating in Medicare and Medicaid would be paid extra to turn over their patients' medical records to a central federal databank, effectively turning their patients into unwitting research subjects for comparative effectiveness.