Tyler Cowen highlights an important point
There is a growing awareness among researchers, including advocates of quality measures, that past efforts to standardize and broadly mandate "best practices" were scientifically misconceived. . .
Orszag’s mandates not only ignore such conceptual concerns but also raise ethical dilemmas. Should physicians and hospitals receive refunds after they have suffered financial penalties for deviating from mistaken quality measures? Should public apologies be made for incorrect reports from government sources informing the public that certain doctors or hospitals were not providing "quality care" when they actually were? Should a physician who is skeptical about a mandated "best practice" inform the patient of his opinion? To aggressively implement a presumed but still unproven "best practice" is essentially a clinical experiment. Should the patient sign an informed consent document before he receives the treatment? Should every patient who is treated by a questionable "best practice" be told that there are credible experts who disagree with the
I’ve probably been guilty of wishful thinking in regards to comparative effectiveness research. There are serious ways in which what works in the lab deviates from what works in the field. It is easy to get over confident when hundreds of billions of dollars in savings are dangled in front of your eyes.
At the same time, however, I still think its a mistake to “trust doctors” on these issues. Comparative effectiveness research may not be a magic bullet but there is little evidence that doctors in the field are any better.
Public medical spending should still be supported by strong science even though more humility is need in pushing scientific results.