But I ask, what about research that leads to proven treatments? Even when the treatments are validated and proven, the payment of such services can often fall upon the patient due to miscommunication of what is covered between the the Service Provider and the Health Care provider.

Why must the responibility of facilitating clear communication between these groups fall upon the patient. They are the only ones that end up suffering.

Some have suggested modeling a comparative effectiveness research agency after the Federal Reserve Board which sounds good in theory. However, as Alan Greenspan points out in his recent book “The Age of Turbulence,” the Fed has about 2,000 employees, a budget of $300 million per year and it’s own funding source from interest on government securities it owns and lending to banks as well as profits from buying and selling government securities. There will always be heavy pushback from providers who may lose business when their treatments are either not covered by payers or deemed to be less cost-effective than alternatives.

I also think that it might be helpful if insurers were not quite as rigidly tied to Medicare in setting fee schedules. If, for example, insurers think that Medicare pays too little for primary care, which could help to keep people healthy, or palliative care, which could reduce healthcare utilization at the end of life, they should be willing to pay considerably more than Medicare if necessary to insure adequate availability of these services which could save money overall for both the system generally and the insurers specifically.