Pamela Hartzband and Jerome Groopman write Rise of the Medical Expertocracy Both Democrats and Republicans want to introduce the paternalism of ‘best practices’ into health care in the Wall Street Journal, 3/31/2012.

The crux of the excellent analysis is that health care is both too complex and too personal to be reduced to a set of best practices that can be determined by a remote elite. The only difference between the Republicans and the Democrats is that the Democrats thinks government bureaucrats are able to make these decisions and Republicans thinks that insurance companies can better make these decisions. Both parties are wrong.

Excerpts:

For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone’s life or how they might experience a treatment’s side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.

For much of the 20th century, the model of medical care was paternalism: A doctor dictated what was to be done and the patient complied. This model has largely been abandoned, but now Democrats and Republicans are offering a new form of paternalism, based on the assumption that Americans are not receiving “quality” care. A lucrative industry has grown up to generate ever more medical metrics, to give report cards to doctors and hospitals, and to base payments on compliance with “best practices.” Yet beyond safety protocols, there is scant evidence that such measures improve our health.

Patients and doctors can differ with experts and not be ignorant or irrational. Policy makers need to abandon the idea that experts know what is best. In medical care, the “right” clinical decisions turn out to be those that are based on a patient’s goals and values.

HKO comments:

Markets allow for the high degree of incrementalism that consumers want. Central control does not. Many proponents of centralized health care blatantly state that most Americans are too ignorant to make their own health care decisions. How utterly arrogant and demeaning.

For example. Pretend two different patients with a brain tumor face a choice of certain death or surgery that has a 25% chance of permanent brain damage and a 75% chance of a compete cure. One patient has had a long agonizing experience with a loved one with brain damage and the other has not. The first may choose not to have surgery because of his or her experience and the latter lakes the odds and seeks the surgery. People make decisions for many reasons well beyond the reach of best practices.

Steve Jobs elected to delay treatment of his treatable pancreatic tumor to try a strict vegan diet for several months. It may now seem foolish, but should he have been forced to accept a best practice that dictated otherwise?

The kind of reform medical care needs is to return control to the patient, and to increase transparency in treatment and billing. Democrat ex Congressman Jim Marshall, who voted against the health care bill, noted the need for doctors to provide the lowest price for payment at time of service. This at least inserts an element of true market pressure that is currently missing in health care.

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