This vote was on an amendment by Jon Kyl, R-Ariz., that would prohibit information obtained through research that compares the effectiveness of different treatments for certain medical conditions from being used to deny medical coverage under federal health care programs such as Medicare.  The amendment was offered to the budget resolution that serves as the blueprint for Congress’ budget priorities in fiscal 2010.  The budget resolution sets overall spending targets for the Appropriations committees and outlines other budget rules.

Kyl said his amendment is intended to ensure that $1.1 billion for comparative health effectiveness research does not lead to rationing of health care.

“Comparative effectiveness research can be used to provide patients and doctors with information so that they may make informed health care decisions. For example, a study might compare a drug versus a surgery and determine that the drug is just as effective or even better at improving a patient's quality of life. But without appropriate safeguards, the Government may misuse comparative effectiveness research as a tool to ration or deny health care, and since private insurers tend to follow the Federal Government's lead, this has significant implications for all patients,” Kyl said.  “My amendment puts patients first. It is a nonpartisan issue. I do not know of anyone in this body who wants the Government to ration care or stifle innovation. I believe in the right of every American to choose the doctor, hospital, or health plan of their choice. No Washington bureaucrat should interfere with that right or substitute the Government's judgment for that of a physician.”

Kent Conrad, D-N.D., said Kyl’s description of the amendment and the actual text shows a “disconnect.”

“I don't see comparative effectiveness.  I don't see that as having anything to do with rationing. Comparative effectiveness research is really to determine what works in health care. It helps ascertain what are the treatment regimes that are most effective at treating different disease states. It is the scientific process,” Conrad said.  “It has nothing to do with our efforts in rationing health care--nothing at all.”

Max Baucus, D-Mont., said American health care costs are far too expensive, and that it is mostly due to waste, and the way in which procedures are approved or disapproved.  He said comparative effectiveness is one way to get a handle on a proper cost structure for health care.

“We need to know the comparative effectiveness of drugs, procedures, medical equipment, et cetera, so we get the best, highest quality, and we, therefore, will probably know which ones will tend to cost more than others. Doctors can make choices, patients can make choices, and insurance companies can make choices as to which procedure, which drug makes more sense. Basically, it is up to the doctor to decide which way makes the most sense,” Baucus said.  “Now, the effect of the Kyl amendment, as I understand, is, frankly, to say that you have to pay for a very costly procedure that somebody deems to be not only ineffective, it may be harmful, and you have to pay for it. That does not make sense. Rather, I think the Senator from Arizona agrees with me, we are trying to figure out a way to use comparative effectiveness to help doctors have more information, and hospitals more information, as to which works better, has higher quality, and works better when compared to something else.”

By a vote of 44-54, the amendment was rejected.  All but two Democrats voted against the amendment.  Every Republican present voted for the amendment.  The end result is that the measure went forward without language that would have prohibited medical research information from being used to deny coverage or treatment under federal health care programs.