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Kai Ryssdal: Now that the health care debate seems to be nearing an end, we're going to take you back closer to the beginning. To last summer and fall, and the days of the arguments that care would be rationed based on how much it costs. That a bureaucrat sitting in a room somewhere would look at a spreadsheet and decide who gets what treatment or medicine. Now that's been turned on its head, where there's really not very much discussion of cost or cost-effectiveness at all. From the Marketplace Health Desk at WHYY in Philadelphia, Gregory Warner reports on our complicated relationship with cost.
GREGORY WARNER: A few months ago, a retired chemist named Mary Stowe was playing the slot machines in New Jersey when she got a huge headache. Then her arm wouldn't move. The next thing she remembers she was waking up in the hospital and hearing she'd had a severe stroke.
MARY STOWE: They told my children I was going to die. And I recovered by some miracle!
Therapist: All right Mar! Let's go sit on the chair.
I met Mary at the Magee Rehabilitation Center in Jefferson Hospital in Philadelphia where she's engaged in the slow process of learning to reuse her paralyzed right arm. To do this she's using something called robotic therapy. A therapist straps her arm to a joystick that Mary maneuvers to hit red dots on a computer screen.
STOWE: I turn it from red to green.
The robot helps her make the movement.
STOWE: I think it's just exercising some little muscle that I don't know about.
Technically it's reawakening a neural pathway in her brain. This robotic technology is still pretty new, and in most hospitals its behavioral therapists who do this work. Mary works with both the robot and therapists, which brings up this cost question...
JOEL HAY: Which of these two alternatives provides more value per dollar spent.
Joel Hay is a health economist at the University of Southern California. He says robots might be more efficient at working with patients because they can perform the same task the same way a thousand times.
HAY: And you'd have to sort of have repetitive boring routines that perhaps a person wouldn't be as good at. On the other hand, a person has other advantages.
Like being able to adapt to the patient's exact needs. In this country we spend $4.5 billion on stroke rehabilitation every year. So Hay applied for a federal grant to research which treatment -- robots or therapists or some combination of both -- is most cost-effective.
Which is when Hay hit his first snag.
I first spoke to him back in January, when provisionary language in the Senate health care bill would have made it illegal to do cost-effectiveness research with federal funds.
HAY: If I as a university researcher were to engage in that research, and publish it, the entire University of Southern California would lose its funding for the next five years.
That language has been removed from the current Senate bill, thanks to advocates like David Helms who runs Academy Health in Washington. He and others lobbied Senators and got that language changed. But he says officials are still wary of funding researchers to do cost-effectiveness studies. He says the fear is...
DAVID HELMS: They may do this work for the government, and then they may turn around and sell the results to a health insurance association.
Which could conceivably force patients to get the treatment that's cheaper.
What doctors fear most is that cost-effectiveness studies will squash innovation and limit patient choice. In health care, policy is shaped by information. And some information is politically dangerous even to pursue.
Michael Hochman is a doctor at L.A. County Hospital. He did a study published in the Journal of the American Medical Association last week. He found that of hundreds of recent articles about drugs in the top medical journals, fewer than 1 percent compared the costs of those drugs.
MICHAEL HOCHMAN: And that is due to both the fact that researchers aren't doing a heck of a lot of cost-effectiveness research but also that journals are choosing not to accept cost-effectiveness studies.
Hochman says that journal editors avoid the topic because its controversial. And because editors are doctors, he says, they're trained to think about what's best for the patient, not what costs less.
HOCHMAN: And, if there's never anything that we read in the medical literature that has to do with cost, it might cause us not to think about the resources that we're using.
Meanwhile, Joel Hay the health economist is still waiting to hear whether the government will fund his research on the robots used by Mary. If not...
HAY: Then, to do those studies I would have to go to the robot industry and certainly there's going to be perception that whoever funded the study is going to influence the results.
Most cost-effectiveness research is privately funded by device manufacturers and drug companies.
While Mary slowly turned more red dots to green, I asked her which one she prefers, robots or people.
STOWE: I like working with both, human beings and dots on a machine. Dots on a machine don't complain as much.
In Philadelphia, I'm Gregory Warner for Marketplace.