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In the midst of the US health care reform debate in 2009, Governor Rick Scott, the founder of the Columbia Hospital Corporation, formed a group called 'conservatives for patient's rights.' The mission of the group was to defeat health reform ideas espoused by the Democrats. On the group's web site, it claimed that President Obama wanted to create 'a national health board similar to the one in Britain that could potentially lead to bureaucrats making health care decisions rather than patients and their doctors' (http://insightonfreedom.blogspot.com/2009/03/conservatives-launch-campaign-for-free.html, accessed 20 November 2014). Scott's group was roundly criticized by many for its inaccuracies (Brown, 2009), but its caricature of National Institute for Health and Care Excellence and the suggestion that expanded government involvement in health care would limit access to 'life-saving' technology echoes decades of attacks by conservatives against government involvement in health care. Every effort to expand the use of health technology assessment, particularly efforts to apply cost-effectiveness analysis (CEA) to health care, have been subject to fiery political attacks. Reflecting this political tradition, the Congress prohibited the Patient-Centered Outcomes Research Institute (PCORI) from using dollars-per-quality adjusted life year as a criterion to address the charge that it would ration care. Even though Congress limited PCORI's ability to conduct CEA, the Institute remains controversial and Republicans hope to eliminate it as part of their agenda to undermine the ACA in 2015 and beyond (Demko, 2014).
In their 2009 article, 'Has the time come for cost-effectiveness analysis in US health care?', Stirling Bryan et al. try to better understand the controversial politics of CEA and identify strategies that might make the use of these techniques politically acceptable in the United States. Their findings remind us that framing and language can have a dramatic effect on policy debates. The fact that CEA is often associated with the word rationing - which is used to evoke fear of inappropriate limits on effective medical technology - creates a political barrier to the use of economic evaluation. Ironically, decision makers are concerned that studies financed by industry might result in the opposite problem. If CEA relies on studies financed by industry, it could lead to the approval and use of drugs and other technologies of...