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June 19, 1996


Author Affiliations

Princeton University, Princeton, NJ

JAMA. 1996;275(23):1802-1804. doi:10.1001/jama.1996.03530470030018

Breakthroughs in the sciences often take the form of replacing 1 hitherto held hypothesis with another. In the social sciences, that process tends to be controversial, because hypotheses usually can be tested only on crude, nonexperimental data that tend to be compatible with numerous rival hypotheses (theories). More often than not, the individual social scientist's allegiance to this or that theory is dictated by that individual's personal predilections.1 A "breakthrough" in the social sciences, therefore, may be nothing more than the triumph of 1 ideology over another.

During the past decade or so, economics experienced such a breakthrough. Certain theories favored by large segments of the profession, the ideology they embodied, and the felicitous jargon they inspired came to dominate the thrust of American health care policy. Goaded in good part by the writings, teaching, and punditry of economists, American politicians increasingly treated health care as just another private