Holt’s Elitism  Matthew Holt writes, “reform of the way Medicare
pays for care, and the way variation in care is to be removed,
are subjects that will be tackled by a group of elites who
actually understand this stuff, out of the view of the public
eye.”  So under Holt’s ideal medical system, the practice of
medicine will be governed by elite technocrats, far removed from
doctors and patients. Concerning this approach, one may ask:  1.
Is it moral?  2. Is it efficient?  3. Is it politically
acceptable?  I believe that the answer is “no” on all three
grounds.  It is immoral because it concentrates power in the
hands of an elite, and it takes autonomy away from doctors and
patients. The news today reports of Art Buchwald’s death, and
the obituaries mention his difficult decisions regarding
terminating dialysis. Taking those decisions away from
individuals and their doctors is simply wrong.  It is
inefficient because the best decisions are made closest to their
point of impact. Are consumers perfectly rational d