And centralizing medicine is worse because every patient is different.

What has emerged as a result of this manipulation of healthcare consumers is that ST is liberally applied without a thorough understanding of its effect on patient health and economic outcomes. Clinical decisions are now being driven by centralized, economically motivated insurance plans rather than by their value to patients. This may lead to lower overall medication uptake and adherence as patients discontinue their medication because of their inability to navigate the complicated ST system. It is interesting to note that the state-based insurance commissions that regulate insurance companies often do not require any type of transparency from the plans they regulate. For example, how to obtain an exemption from the first-line therapy and what constitutes as failure are not often clear to either patients or their health care providers. The key problem with centrally planned medicine implemented by plans is that it uses a “one-size-fits-all” approach, which is inappropriate when each patient has unique symptoms and side effects, making them respond differently to mandated choices. This problem is not exclusive to ST, but encompasses all health plan restrictions, including differential copays, pre-authorization rules, and quantity limits on prescriptions. What works for one patient may not work for another – this is best understood on a decentralized level, as a patient and his (their) doctor typically know what’s best for that given patient. Thus, the goal of a plan’s policies should be to promote the optimal matching of patients to existing therapies rather than to declare, without medical expertise, that one therapy is better than another for everyone. This is the fundamental issue with centralized versus decentralized medicine.