This morning's must-read:

In a new article in Health Affairs, Gail Wilensky, a Republican adviser and former head of Medicare, argues for limiting comparative effectiveness research to clinical outcomes, and leaving cost-effectiveness calculations to payers, whether private insurance firms or government. . . .

And in the news:

While business lobbies object to a provision in the House health care reform bill that would slap an eight percent payroll tax on companies that do not provide health insurance for their workers, Senate Democrats cite the need for some kind of pay-or-play provision to prevent companies from dumping health insurance altogether, the New York Times reports. Individuals will be required to buy insurance and given subsidies if they couldn't afford it under either version of the bill. . . . Cash-strapped governors take their case to the White House for limiting new state obligations in any health care reform legislation, the Washington Post reports. . . . 

In a Times editorial on the Pharmaceutical Research and Manufacturers Association offer to cut drug prices by $80 billion over the next decade, the Times says "Congress and the public should see these proposals as an opening bid and not the final word." . . .

Opinion city: An op-ed in the Times by David Riemer of the Community Advocates Public Policy Institute in Milwaukee and Stanford business professor Alain Enthoven says more insurance industry competition is key to lowering health care costs. They propose limiting individual insurance benefits to the price of the lowest cost insurance plan registered with one of the state exchanges created under the Senate health reform plan. The op-ed is silent on minimal coverage requirements on those low-cost insurance plans. . . . Columnist Nicholas Kristoff weighs in in favor of the public plan through interviewing President Obama's 70-year-old former doctor and David Himmelstein, a leading single-payer advocate with Physicians for a National Health Plan. . . . Over at the Wall Street Journal, regular columnist Karl Rove claims Obama's support for a public plan will undermine his popularity. He cites a poll from Resurgent Republic, a new right-of-center lobbying group he recently helped form. . . . Regular Journal columnist and American Enterprise Institute fellow Scott Gottlieb continues his war against government using comparative effectiveness research when making payment decisions (he calls it rationing) while conveniently ignoring the many times Congress, responding to industry lobbying, dictates what Medicare must pay for despite the absence of evidence. . . .  Letters to the Times suggest insurance industry competition will devolve to "a race to the bottom" and challenge the idea that Medicare pays less than insurance companies for primary care. . . .   

The Wall Street Journal reports on the Obama administration's stepped up war on Medicare fraud, while the AP and Journal cover a Congressional hearing on the UnitedHealthGroup subsidiary Ingenix, which is accused of manipulating data that results in decreasing costs for insurance companies and increasing out-of-pocket costs for individuals. . . .  

FDAWebview (subscription required) reports that newly approved cancer drugs that were given priority review status by the Food and Drug Administration were twice as likely to get subsequent label revisions compared to drugs given standard review, according to a new study in the American Journal of Public Health. The results didn't surprise Richard Pazdur, chief of oncology drugs at the Center for Drug Evaluation and Research, since "drugs that are given priority review status and accelerated approval tend to be more novel drugs (these drugs offer advantages over available therapies) and greater experience with these drugs with time may yield unique adverse reactions that are only discovered with greater use and follow-up.". . . Consumer groups ask the FDA for more transparency in its dealings with the public. . . . 

Preparing for the 2011 expiration of its patent on the blood thinner Plavix (the world's second best-selling drug), Sanofi Aventis plans cuts in its research and development budget and a major push into generic drugs, the Wall Street Journal reports. . . .