Too Much Money

In a recent piece in Science, the author seems to bemoan the reduction of budgets for AHRQ. The writer states:

Those who want to trim or eliminate AHRQ argue that its work overlaps with NIH research. To make his point, Representative Andy Harris (R–MD) points to the $1.37 billion that NIH spends each year on health services research and $1 billion for studies of patient safety .... Others say AHRQ overlaps with the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit supported by a trust fund that was created by the 2010 Affordable Care Act. PCORI now spends about $500 million a year on studies looking at which of two treatments works better, an area known as comparative effectiveness research.

The real issue is not AHRQ, which Congress can control, but PCORI which lies outside of Congressional control. PCORI was setup by the Democrats as a petient input entity funded by the fees imposed in the ACA. PCORI is another of those unregulated by Presidentially appointed rogue entities whose value is highly questionable. Thus Congress targets AHRQ since it cannot do so to PCORI. The real question is; what value is PCORI? Its funding expires in 2018 so Congress believes if it reduces AHRQ, laudable because of putative duplication, then it can just let PCORI die on its own.

The author continues:

AHRQ has attracted critics in the past because its work can threaten the financial interests of some groups. In the 1990s, Republicans tried to shut down the agency after spine surgeons objected to a report that found rest and pain medications worked as well as surgery for back pain, notes one commentator. Simpson says it’s important to have a U.S. agency that keeps a close eye on health care quality, noting a 2011 Institute of Medicine report that found 30% of the $2.5 trillion the United States spends annually on health care is wasted on unnecessary services and other needless costs. “With that amount of waste, it’s shocking that people talk about duplication of AHRQ research,” she says.

This is really a red herring. The issue of lower back pain has been examined in multiple venues and this is in my opinion merely an attempt to justify AHRQ. The real issue is; how can anyone justify PCORI?