Problem Solving in a Polarized Age: Comparative Effectiveness Research and the Politicization of Evidence-Based Medicine

This essay uses the case of the "medical evidence gap" to illustrate how polarization and party competition can undermine efforts to solve a societal problem. Policy experts associated with both parties agree that the lack of hard evidence about what treatments work best for patients with different conditions is a significant health care problem, and that greater investments in "comparative effectiveness research" (CER) would enable patients, providers, and payers to make more informed decisions. Until recently, CER was a technocratic, third-tier issue. Over the past year, however, CER became highly politicized because it got caught up in the partisan struggle over universal health care reform. The story of how CER morphed into a symbol of crude rationing schemes and government interference with the doctor-patient relationship offers a cautionary lesson about the limits of pragmatic governance in an era of polarization.