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ObamaCare: Yesterday’s Failures Today

The ObamaCare rollout has been such a mess that explaining its manifold failures has become somewhat complex. But basic news coverage of the law is still studded with quotes that, while describing individual weaknesses of the law, would serve as succinct summations of the government’s incompetence. Today’s New York Times story offers a couple of good candidates.

The back story, briefly, is that last month more results from the Oregon Medicaid study were released, further undercutting the central claims of ObamaCare. Part of the recriminations that followed had to do with the fact that the government had not been utilizing randomized studies, which are considered the “gold standard” in medical research, when planning out ObamaCare. Today the Times carries a story on how ObamaCare is funneling taxpayer money into new research facilities–and you won’t be surprised to hear that the government’s new facilities are not using the most reliable methodology:

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.

The story then quotes health experts complaining about the missed opportunities. And what is the government using instead of the “gold standard”? The Times explains:

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.”

That is the first of two classic quotes from the story underlining the government’s failures: “If it does not look like it is working, we can stop.” That’s not, apparently, the case with ObamaCare. It doesn’t appear to be working but the government’s natural tendency when watching bad money float away is to toss good money in after it.

But the better candidate for “ObamaCare in a nutshell” comes from the Times’s description of the activities of two health experts, one of whom was involved in the Oregon study. The Times notes the fact that the U.S. has been slow to use randomized studies despite their accuracy, and then adds:

The situation is different in the developing world. There, randomized trials have become common in health care and other areas, sponsored by a variety of groups like J-PAL, a global network of researchers that was organized by M.I.T. and Harvard economists.

So far, J-PAL has conducted over 440 randomized trials in 55 countries, according to Amy Finkelstein, an M.I.T. economist.

Dr. Finkelstein and Lawrence Katz, a Harvard economist, have now started J-PAL North America to spur randomized trials in, among other areas, health care.

So there you have it: in order to fix one of ObamaCare’s weaknesses, experts are importing methods from the developing world.

Now, in fairness to the administration, the lack of randomized trials is an issue across the board–it’s not a problem invented for or by ObamaCare. But it’s still quite telling that with a blank slate (and a practically blank check of taxpayer money) the government founded an Innovation Center to take us into the future of government health-care services with the past’s outdated and maligned systems and practices.



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