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.