A good friend sent me an article on “patient‐​centered health care” written by Dr. Donald Berwick, President Obama’s intended nominee for administrator of the Centers of Medicare & Medicaid Services. What an improvement an administrator like this will bring compared to his predecessors! Right? The article is called What ‘Patient‐​Centered’ Should Mean: Confessions Of An Extremist (requires login).


I have no doubt of Berwick’s sincerity, but the essay gives me little hope for progress. It doesn’t mention, for example, parity in the tax treatment of employer‐​purchased and individually purchased health insurance.


Why don’t we talk about diner‐​centered restaurants or grocery stores? Because when consumers select restaurants and stores, choose their food, and pay for their choices, “diner‐​centeredness” is a given. To the extent non‐​diner‐​centered food outlets have come into existence, they’ve gone away again as a failed business model. Nobody has to discuss what it means or what artificial process they would use to deliver “diner‐​centeredness.”


“But health care is essential to life!” some might argue. “Intellects and government officials must pay health care delivery special attention because without it people would die.”


Pray tell, good hearts, what is food other than an essential of life without which people would die? We regard food provision an “easy” problem because we haven’t made it hard by fettering the market for edibles the way we have health care.


Keep your eye on the ball. If you have to discuss how to get patient‐​centered health care, you’ve framed the problem wrongly. (The medical metaphor is talking about a symptom and not the disease.)


“Patient‐​centered” is implicit when the patient is actually at the center. Dr. Berwick should approach the health care delivery problem with a little less poetry and a little more economics.