Who decides what care is worth the cost?

Read Keith Hennessey. A taste:

You have three options for who gets to choose whether the marginal benefit of a given medical treatment or health insurance benefit is worth the marginal cost. I think of them as “levels”:

1. government;
2. insurers & employers; and
3. you (with advice from your doctor).

They key analytic point is that whoever controls the money makes the decision. To oversimplify, the higher you push the decision, the more you can redistribute among people. The lower you push the decision, the more efficient you are. I think that certain political realities also will affect the total amount of resources dedicated to health care, depending on at which level the decisions are made.