Some years back, I had a heated discussion with a physician who thought the key to better health lay in more intimate involvement of doctors in the lives of their patients—the doctor as life guide. I argued that her aspiration was noble, but that in a country of 200,000 primary care doctors treating 320,000,000 patients—many transient and most outside the elite bubble—her idea, while great when it works, would mostly serve the fortunate few.

This bias—focusing on what motivates ourselves and our similar acquaintances—permeates healthcare policy with an unintended and sometimes destructive elitism. Psychologists call this the “fall consensus effect”—assuming everyone else is like us. In rare acts of bipartisanship, we devise well-meaning policies that squander scarce resources on efforts that do relatively little for those who are most likely in need of assistance.