We write often about how inefficiently we provide care in the U.S., and how a top order of business for the next administration should be establishing a comparative effectiveness entity to help sort out what works and what doesn't. A story in today's New York Times about a court ruling on Medicare spending stresses the importance of having independent analysis about effectiveness.

The article reports that a Federal District Court in Washington blocked the Bush administration's effort to save money on Medicare by paying only for the least expensive treatment for a condition—in this legal case, chronic obstructionary pulmonary disease.

The administration wanted the Health and Human Services Secretary to have more discretion over Medicare payment policies. The judge said Congress sets detailed formulas.

We think this begs an important question. Do lawmakers really know whether drug A or drug B is really better for COPD? Do cabinet secretaries? The answers should rather be based on independent, reliable, untainted science and public health data. You can't make cost-benefit analysis without knowing the benefits. And if we really make an effort to get good data, to pay for effective quality care and not waste so much money on unproven or outright unnecessary care (maybe $700 to $800 billion a year), the cost piece of that equation may not be quite so daunting.