For the most part, we're avoiding [the subject of cost effectiveness] when we talk about health care. When the Patient Centered Outcomes Research Institute, the body specifically set up to do comparative effectiveness research, was founded, the law explicitly prohibited it from funding any cost-effectiveness research at all. As it says on its website, We don't consider cost effectiveness to be an outcome of direct importance to patients." As a physician, a health services researcher and a patient ... I think understanding how much bang for the buck I, my patients and the public are getting from our health care spending is of great importance. The United States Preventive Services Task Force ... was set up by the federal government to rate the effectiveness of preventive health services on a scale of A to D. When it issues a rating, it almost always explicitly states that it does not consider the costs of providing a service in its assessment. And because the Affordable Care Act mandates that all insurance must cover, without any cost sharing, all services that the task force has rated A or B, that means that we are all paying for these therapies, even if they are incredibly inefficient. If we are going to mandate that recommendations and interventions must be covered by health insurance ... it seems logical that we at least consider their economic value.