The Politicization of Evidence-Based Medicine: The Limits of Pragmatic Problem Solving in an Era of Polarization

A key test of a political system is its capacity to solve important societal problems. Few policy areas in the U.S. are more problem-ridden than health care. Medical care is expensive and wasteful, and the quality often falls short of best practice. One idea to improve health care is to eliminate gaps in the medical evidence base through “comparative effectiveness research” (CER). By identifying what treatments, tests, and technologies work best, CER could help doctors, patients, and payers make better decisions and help reduce wasteful spending. CER was a technocratic, third-tier issue familiar mainly to policy experts based in universities, foundations, and think tanks, but hardly anyone else. This paper traces how this obscure policy initiative got caught up in the wider ideological struggle over national health reform.