In the American Spectator David Catron points out a disturbing quote from Medicare & Medicaid Services head Donald Berwick is.

Berwick’s view of rationing is, in fact, the opposite of [Paul]  Ryan’s. The latter believes it should be driven by the informed decisions of consumers in a free market, while our new CMS head has summed up his contempt for the intelligence of patients as follows: “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

The hidden premise here is that if doctors, patients, and insurers are free to contract with each other as they please, they won’t do what Donald Berwick wants.  To authoritarians like Berwick, we’re all pawns to be used by the “leaders.”  As economist Frederic Bastiat wrote in The Law (1850):

Socialists look upon people as raw material to be formed into social combinations. This is so true that, if by chance, the socialists have any doubts about the success of these combinations, they will demand that a small portion of mankind be set aside to experiment upon.

Berwick’s comment also reveals ignorance about how free markets work.  No single person, or group of “leaders” knows how to configure a health care system. They do not even know how to manufacture a simple wooden pencil. See Leonard Read’s classic I Pencil. Or watch Milton Friedman explain: