GOOD CARE? WHO KNOWS? In The Wall Street Journal, more empirical scorn is being heaped on consumer-directed health care, this time in the form of a study showing that consumers have absolutely no idea what good health care is. Researchers from the RAND Corp., UCLA, and the Department of Veteran's Affairs had 236 elderly patients in two major managed-care plans rate the quality of their health care. Satisfaction was high, with the average rating a super 8.9 out of 10.

Then the researchers sat down to rate the care that these same patients received. They compared care received to care that should have been received, taking into account fundamental metrics like whether a patient received Aspirin within an hour of being diagnosed with acute myocardial infarction. Scores plummeted. Despite the high level of patient satisfaction, the researchers gave the care a failing grade of 5.5. More interesting, the patients who rated their care as a 10 were just as likely to be getting low-quality care as those who reported a 5.

The problem? Patients are not qualified to evaluate good care. They're qualified to evaluate whether the doctor was nice to them, whether he or she explained things clearly, whether the wait time was short and the experience pleasant. They do not know how well their care matched up to accepted standards of care, and they do not know whether the treatments they were given were comprehensive, well-targeted, or adeptly conducted.

This is why consumer-directed health care is a silly idea. Consumers may be able to trigger a revolution in waiting room reading material and operating room decor, but if the doctor's diagnoses are delivered in a confident tone and he or she is kind while carrying out their treatment, patients have no capability to separate good medicine from bad. The concept that individuals are qualified to act as oversight for doctors has always been foolish, but now, again and again, it's being proven so. And why shouldn't it? There's a reason we accept expertise in our society, a reason we encourage specialization and comparative advantages. If doctors need watchdogs, then we need to empower institutions or individuals with the education and ability to actually watch over them. Patients, for all their good intentions, are easily fooled by a firm handshake, a pleasant nurse, and a well-decorated waiting room. Important as those things are, they shouldn't be the fundamental metrics for evaluating health care.

--Ezra Klein

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