Abstract

Problems in the field of health law often force tradeoffs between uniformity and particularity in health care decision-making. Patients are highly diverse in terms of their basic health status, willingness to accept risk or uncertainty in new treatments, and ability to pay for care. And health care experts - doctors, research scientists, insurance company reviewers, and health economists - are similarly diverse in their perception of the best treatment and payment structure choices. In a world with such persistent heterogeneity of opinions and preferences, a society's choice between centralized rules for treatment and payment and a more diffuse decisional regime is both crucial and controversial. Opt for a uniform national rule - say, a federal statute governing treatment standards, drug approval, or health finance - and many beneficial autonomous transactions between doctors and patients are squelched, with possible detrimental effects on population health and medical innovation.