We have been told that the Affordable Care Act will do great things for medicine. Nothing much good can come from the private sector but the government is wonderful at innovation. That is the story, anyway.
But it turns out that the means of measuring this social good are not trustworthy. Rather than real science, we get a propaganda factory.
Gina Kolata, the New York Times’ science writer, explains:
The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade.
But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs.
So the “Innovation Center” is not going to use a “rigorous method.” It is not going to appeal to “the gold standard in medical and social science research.” (Why should it if the gold standard isn’t even permitted in the nation’s currency?) What are they going to do instead?
Instead, the Innovation Center has so far mostly undertaken demonstration projects; about 40 of them are now underway. Those projects test an idea, like a new payment system that might encourage better medical care — with all of a study’s participants, and then rely on mathematical modeling to judge the results.
Dr. Patrick Conway, the director of the center, defended its reliance on demonstration projects, saying they allowed researchers to evaluate programs in the real world and regularly adapt them. “Does it look like it is working?” he asked. “If it does not look like it is working, we can stop.”
In other words, it will be a waste of money. It will be mostly propaganda assuring us that we are all better off with Obamacare.