Quietly embedded in the giant stimulus bill that will soon become law is a powerful tool that could unlock the door to reforming America's health system -- the creation of electronic health records that can be mined to determine how patients are treated and the degree of resulting success.
Creating a system to provide evidence on what works both enables those who want to squeeze waste out of the system and offers the possibility of freeing up funds to expand care to those who cannot now afford it.
Conservatives, who fortunately have elected not to participate in the debate over the bill, are sounding the alarm in their typical overstated way assuming that anything that can happen will actually occur. They should know better.
In fact, the bill won't require evidence-based care, but will enable us to better define it. How much coercion will ultimately be required to convert research into recommendation into requirement is a question for another day. In fact, it will be several years before information becomes available.
The hours spent by Peter Orszag, who made educating Congress about wasteful medical spending a top priority during his recent service directing the Congressional Budget Office, were apparently well spent. Orszag, who's now director of the Office of Management and Budget argued that many costly interventions were a poor investment, but couldn't be weeded out until research provided a specific menu of what worked.
Language in the stimulus bill creates a structure that could write such a menu, a goal also suggested by sometime HHS Secretary and health reform czar designate Tom Daschle.
In both his current job and his past one, Orszag had the role of scoring legislative proposals, a task that requires balancing new spending, which is not rocket science, against proposed savings, which is a much more difficult chore. He's the gatekeeper charged with subjecting proposals to a reality check.
That means, to cite a hypothetical, that he'd reject assertions that a proposal to provide poor people with vouchers to health clubs would be cost-free because the resulting exercise would improve their health status and reduce the need for later medical care. That logic may hold, but there's no evidence now that supports it.
Creation of an evaluation system based on information technology is a major victory, but it doesn't mean that the war has been won. As I've warned elsewhere, the next steps won't come easily. Already a coalition of disease-based groups backed by drug money is beating the drug for choice -- a concept that wins public acceptance on issues ranging from abortion to schooling.
In this instance, they're arguing that treatment choices should be left to patients and providers working together rather than evidence-based algorithms that they choose to derisively call cookbook medicine, as if using a tried and tested recipe is somehow un-American.
But observers who think fixing America's health system has been put aside with today's focus on repairing the economy may be surprised when the dust clears.