By Evan Falchuk

It should be easy to define health care quality: did the patient get the right diagnosis and treatment?

But it’s not. And it’s because of something Al Gore wrote about in the 1990s.

Government, Gore said, gives consumers the lowest priority:

The first priority was the rules; the second was those who checked whether the rules were being followed…; the third was those who made the rules in the fist place…Customers came last, if at all. It was a sort of “iron triangle” — special interests told Congress what “the people” wanted; Congress passed laws, and then told the agencies what to do about them.

Gore was talking about something very analogous to health care quality: worker safety. The government spent decades trying to improve safety by measuring not by whether they could lower their accident rates, but by whether they could follow thousands of pages of rules. The question of safety had become lost and accident rates didn’t drop.

It’s happening now in health care.

The government says that quality means getting the right care. But there are signs of creeping OSHA-ization: it also says (same link) that quality means striking “the right balance” by avoiding “underuse,” “overuse,” and “misuse.”

And so the government has catalogued almost 1,500 new “quality measures” to define that “right balance.” No provider could possibly be aware of all of these measures, how they might apply to their patient, or have any sense of how they might end up being used to measure them. Worse, no consumer can possibly understand what they mean.

Patients aren’t interested in the right balance, just the right care.