Once again I feel the need to reiterate that my comments about health care are personal opinions only, and do not reflect anyone’s positions but my own.
Part of the reason I am so opposed to the private delivery of health care is that the market tends to work on a principle of caveat emptor – let the buyer beware. The problem with this generally-sound skeptical principle when it is applied to health care is that people are not “buyers” of health care, nor can they said to be “consumers” in the same way as someone walking into a hardware store or restaurant. A hefty proportion of our interactions with the health care system are in times of crisis, meaning that it is unreasonable to expect us to do the kind of cold, rational calculus that one might expect of someone choosing a realtor or a bottle of fine scotch.
Congruent with this issue of need-based service consumption is the incredibly high bar of education required to understand how the health care system works. Most people are capable of understanding a basic supply chain, and can usually navigate the hoops needed to ensure they don’t get screwed on a car loan or a warranty on their stereo (although not always, which is why we have consumer advocacy and protection groups). The kind of education needed to understand health care is, to put it mildly, extensive. Regardless of which country you live in, health care systems are often fragmented and convoluted. Even those who work within the system have difficulties navigating it – how could a lay person possibly expect to do better? This question becomes more acutely important when you consider the fact that those laypeople are in crisis while trying to do it.
It is for this reason that we are best served when treatment decisions are made based on the evidence, as interpreted by people who are educated enough to understand it. While it seems unfair that your medical care might be guided by someone you’ve never met, it is far preferable than being pressured into decisions you don’t understand – particularly at a time when you are particularly vulnerable to either manipulation by outside agendas that may not have your best interest in mind, or when you are psychologically less able to make rational, informed choices. While patients must have the right to make the ultimate choice about their care, we are best served as individuals and as a system when the choices available to us are based on the best evidence rather than our own ‘best guesses’.