Americans want to know how good their doctors and hospitals are. But the government does not reward good performance — judged by whether patients get better. It rewards only good conformance — for medical providers who follow its recipes.
The government specifies its recipes like the 11th Commandment. But there is no one recipe for medical care. Treatments must be tailored to patients. Are drugs that lower blood pressure really mandatory for all heart failure patients, as the government avers? Doctors who keep blood pressure slightly elevated in their elderly patients' rigid vessels surely don't agree. Further, medicine is the youngest science, with frequent flip-flops in accepted treatment. Yesterday's must-dos, Vioxx and antidepressants, are today's tort lawyer bonanzas.

Government recipes are delineated primarily through "peer review," not scientific experiments. Although the title implies saintly physicians dispassionately evaluating each other's work, medical "peers" become brass-knuckle fighters when innovators threaten their expertise. The history of medicine is filled with shameful suppressions of important advances.

The government's demand for minutely-detailed records that demonstrate adherence to every step in its recipes may be the straw that breaks the back of providers' strained information-technology systems.

Government's appropriate role is to measure outcomes — the real performance of doctors and hospitals. Disclosure was President Franklin Delano Roosevelt's solution. Instead of dictating recipes for hard-hit Depression-era businesses, he created the Securities and Exchange Commission to promulgate audited financial outcomes, measured by generally accepted accounting principles. The resulting transparency is essential to financial markets that reward good firms and penalize laggards. Sunshine is the best disinfectant.

Want Uncle Sam to be your doctor? Or should he enable you to understand just how good your doctor is?

Regina E. Herzlinger is the author of “Who Killed Health Care?”, the McPherson professor at Harvard Business School and a fellow at the Manhattan Institute

©2007 USA Today