Modeling health reform on the NFL

In a previous column, I suggested that America should get NICE-er. No, the post did not refer to reaching out to Iran. Rather the column argued that health system reformers should establish a group to guide health-related decisions in the U.S. similar to the National Institute for Health and Clinical Excellence (NICE) in the UK. Unfortunately, a guidance organization like NICE probably won't appear in America any time soon because America abhors adopting elements of foreign health systems. Yet health reformers should try again, and this time they should remind constituents that nothing is more American than a guidance committee tinkering with an important institution - just look at the NFL.

The NHS established NICE in 2008 as a non-governmental institution with the mission of providing efficacy, cost-effectiveness research, and independent guidance for England's National Health Service (NHS). Despite some controversy, NICE has helped the NHS recognize the limits of care resources and make tough decisions about health spending. Although the stimulus bill refreshed some cost-effectiveness research efforts, Americans will have to wait for the health system to become NICE-er since the good work by the Senate Finance Committee and other health reformers on Capitol Hill has focused on insurance reform rather than expansion of efficacy analysis.

Research (some of it performed by my employer) questioning the ability of cost-effectiveness analyses to decrease costs explains part of the reason that a NICE-like institution lost favor on Capitol Hill. But there must have been other factors that helped kill the proposals since representatives seeking to "bend the cost curve," now seem willing to disregard this aim - by expanding health insurance coverage, for example.

Examining the lack of support for the "public option" helps explain why few health reformers support cost-effectiveness research. In particular, the public option is losing clout because of America's aversion to government-run medicine. While President Obama continues to stump for a federal insurance plan to compete against private insurers, constituents' objections have caused other politicians to hesitate. As such, passage appears unlikely. This desire to avoid steps toward socialized medicine has also likely contributed to the scarcity of proposals for NICE-like organizations. Americans might begrudge Britain's superior WHO health ratings but they remain afraid of the NHS.

This fear of following England's lead is unfortunate. Health care resources are limited and Americans should study how to maximize health expenditures. Therefore health reformers should renew their push for expansion of cost-effectiveness analysis. One way they might win constituent support for a NICE-like institution is by pointing to the success of other - quintessentially American - counsels designed to advise governing bodies about rule changes. Namely, health reformers should highlight the competition committee of the National Football League.

The NFL's competition committee helps the league tweak the rulebook almost every year. This independent group, consisting of eight general managers and coaches reviews proposals from teams and recommends changes. Small decisions, such as renewing points of referee emphasis, are installed by the committee without further discussion. On more weighty issues like overtime rules, the competition committee offers recommendations then team owners vote to determine changes. Controversy often meets the committee's decisions since the 30 owners rarely share opinions and the rule changes often involve significant financial consequences. Nevertheless, the competition committee helps these diverse stakeholders determine priorities and reach compromise.

America's health care system needs this type of guidance. An independent advisory organization would help decision-makers avoid the influence of drug companies, physician groups, insurers, or other stakeholders. The group could even consist of representatives from these different groups and thereby diminish the sway of a single interest. By analyzing effectiveness data and limiting choices in a cost-constrained environment the organization would help optimize health care dollars. To mobilize support for this type of cost-effectiveness analysis institution, reformers could point to the NFL's competition committee. This would allow Americans to become NICE-er without having to look beyond the border.