If the patient is paying, then why shouldn't he be making the decision? I'd certainly hope the MD would provide guidance in that decision, since it's the MD wh

If the patient is paying, then why shouldn't he be making the decision? I'd certainly hope the MD would provide guidance in that decision, since it's the MD who knows what the costs and benefits are. But the MD knows neither the patient's marginal valuation of the costs, nor of the benefits. That is, he doesn't know how precious each dollar is to the patient, nor the fact that, e.g., he is resigned to his terminal illness but just wants to live long enough to see his daughter graduate. Since nobody else knows how much those things are worth to the patient, nobody is qualified to balance them. Most especially not politicians, who ought not to have a horse in the race at all. The availability of the treatments ought to be metered by the price of providing them versus the patient's (or the patient's contracted insurance provider's) willingness to pay (given an understanding of the treatment as guided by the MD). Period.