Zero Credit Policymaking : Governmental Performance, Partisan Polarization and the Politics of Evidence-Based Medicine

A key test of a democratic government is its capacity to solve collective problems. Many blame poor governmental performance on bureaucratic incompetence and the influence of special interests. In this essay, we offer an alternative perspective on the politics of governmental underperformance. We introduce the concept of “zero-credit policymaking” to describe a situation in which problem solving generates few rewards for political actors. We illustrate our argument through a case study of the politics of “comparative effectiveness research,” focusing on the capacity of American national government to eliminate medical evidence gaps that impose significant costs on patients and taxpayers. Our analysis suggests that serious policy problems can persist for long periods of time and highlights some subtle mechanisms through which partisan polarization degrades governmental performance