In our society, we value choice very highly.  Sometimes, however, choice is not a universal good.

A tip of the hat to Joe Paduda at Managed Care Matters for linking to the California Health Care Foundation report on consumer choice in health care (both benefits side and services side), which concludes that the clutter of information and the dizzying array of choices are more harmful than helpful to consumers.

David Williams, at Health Business Blog, muses about the parallels between the shift from defined benefit retirement plans to 401(k) plans and the shift from employment-based health insurance to employment-related HSAs and HDHPs.  He writes:

I heard several times this week at the World Health Care Congress that if they’re given the tools to do so, consumers will take responsibility for their health care as they’ve taken responsibility for their retirement savings.

His conclusion: it hasn’t really happened with retirement planning, and it ain’t about to happen in health insurance and health care planning either.

A single payor system would certainly limit choices and reduce confusion, but that’s just as certainly not on the horizon.  To torture the analogy a bit further, that would be like moving from 401(k) plan dominance back to a defined benefit plan or, hey, even a fully-funded Social Security system — in other words, away from consumer-directedness and back to paternalism.

Back on planet Earth . . . we’re moving in the direction of consumer-directed health care because self-determination and choice are fundamentally good, right?  Far be it from me to invoke paternalism as a social good, but it seems clear that as consumers we, collectively, do not have the wisdom or data at our fingertips necessary to make the best decisions about health care benefits or services.  Despite the protestations or promises of the Revolution Healths of the world to the contrary (see related post here), this market has a long way to go before it can be considered mature.

David Harlow