“Millions of Americans suffer every day because we sidelined one word from our health reform debates: equity. They endure health systems that treat them as second-class patients. They undergo partial procedures because it is all they can afford. They seek emergent treatment years after preventive therapies were indicated. They die waiting for undelivered care. The public debate around the American Health Care Act (AHCA) is the latest reminder that health care is, well, complicated. Care is delivered by many practitioners. Costs march inexorably upward. Change one part of the system, and it affects many other parts of our fragmented, but interrelated, health care networks. Yet health care might be less complicated if we returned that missing word to the center of our debate. Forty-five years ago—in March 1972—the Scottish physician Archie Cochrane delivered a lecture that still shapes our health care debates. In discussing how a physician should select a treatment for a patient, he concluded that a physician should administer treatments whose efficacy had been demonstrated through a randomized controlled trial. He called this kind of trial a “very beautiful technique,” in which research subjects were randomly assigned to various treatments as a way to minimize bias.”
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