James Knight on ‘Does the Doctor Need a Boss?’

Dr. James G. Knight (M.D.) is the CEO of Consumer Directed Health Care, Inc. Below, he shares his thoughts on “Does the Doctor Need a Boss?“, a paper coauthored by Arnold Kling and me that has sparked a debate within the consumer‐​directed health care movement.

RE: Does the Doctor Need More Bosses?


My brother had a job in big business where he reported to more than one boss. Needless to say, it didn’t work out well for him.


Doctors ought to have just one boss, their patient. Patients must be allowed to work with the advice of physicians of their choosing and must have the right to make their own health care decisions. Patients must also have meaningful financial responsibility for the decisions they make. Everybody else is superfluous, except to the degree they too have a share of the financial responsibility.


If fee‐​for‐​service has been corrupted by the average physician performing unnecessary services for monetary gain (a premise I totally reject as a mean physician characteristic), then by converting to salaries or capitation these same “corruptible” physicians will be able to profit more by being lazy, doing less, and avoiding the sickest patients; a combination of both greed and sloth versus greed alone.


Cato believes in individual liberty, limited governments and free markets. In my view, big government and big corporations are very often equal threats to individual liberty. As a nation we need a big military to provide for national defence and a few big corporations that can complete huge projects that individuals couldn’t possibly accomplish, but health care is the application of the intellectual rights of individual professionals delivering care to just one patient at a time.