So you’re a state employee in Washington State and you’re lying there on the operating table waiting for your heart surgeon to unblock a clogged artery with a stent. That doctor may think the best kind of stent for you is one that is drug coated. Studies show it improves the quality of life for recipients. But it also costs about $2,000. more than the standard bare metal stent or BMS. A panel of 11 health care professionals has decided that the state will only cover the cost of the drug coated stent in the worst cases where re-blockage is deemed likely. So your doctor doesn’t have a choice. You’re getting the BMS.

This scenario is a glimpse into what some would like to see happen across the United States. In fact, in the stimulus bill Congress set aside $1.1 billion to create a Federal Coordinating Council for Comparative Effectiveness Research. Supporters say it’s good public policy and will reduce the spiraling cost of health care. Opponents call it rationing and government interfering with the doctor-patient relationship.

In Washington State the Health Technology Assessment group has made a half dozen binding decisions and several have been controversial. The panel decided to not cover a virtual colonoscopy because it is more expensive and no more informative than a regular optical colonoscopy. Many health care professionals believe that because the virtual test is less invasive it would encourage far more people to get screened for colon cancer. But the panel went with a survey that showed only a marginal increase and decided that wasn’t worth the extra cost.

One of the doctors on the panel compared it to grocery shopping. “You may want filet mignon, but you can’t afford it,” says Dr. Brian Budenholzer. “At some point, we will have no choice but to look at health care services and ask, ‘Are they good value or not?’ Around 750,000 Washingtonians; those state workers, Medicaid recipients and people on workers comp are now officially eating chicken.