Many people harbor the unspoken assumption that health care is quite a bit like Santa Claus, every month of the year.

What's not to like about Santa Claus? The typical 7-year-old who celebrates Christmas intuitively believes that:

  • The more stuff Santa gives you, the better
  • The best presents are the ones with the newest, greatest technology
  • The more expensive the gifts, the better
  • Santa doesn't make mistakes.

What does that picture have to do with health care? Point for point, the typical adult in the U.S. holds very similar beliefs about health care. According to research by Kristin L. Carman and others published in Health Affairs online, many people believe:

  • "More care is better care," meaning that it is higher quality, although research repeatedly shows that too much care often harms people because of side effects and complications that swamp the benefits of the additional treatment. For example, up to 30 percent of hospitalizations of older patients are related to problems they experience with medicines prescribed for them.
  • "Any new treatment is improved treatment," even though studies have shown that some older treatments work better and cause fewer side effects than newer treatments. For example, older drugs were found to do a better job controlling blood pressure than newer drugs, which cost 20 times as much.
  • "More costly care is better care," despite the fact that researchers have typically found no connection between the cost of care and its quality. For example, the Mayo Clinic is known for delivering high quality care, but typically costs less than other sites whose care is not as good.
  • "All medical care meets minimum quality standards," even though research has shown that people receive appropriate care only about half of the time, and that avoidable side effects and complications are common. For example, about 600,000 people develop blood clots as a result of hospital care, and a third of them die as a result - even though blood clots are considered largely preventable.

While children experience the constant threat that Santa won't bring them presents if they aren't good, most people would say that the health care system keeps giving them treatments even if they haven't been particularly "good" - if they are overweight, if they smoke, if they don't exercise, etc. In fact, they may get more care.

Other research has shown that people often judge quality of care based on the number of prescriptions and other treatments that they get - the more treatments, the higher they rate the quality of care.

It's not hard to make the case that many people view health care as if it were Santa Claus.

How does Goldilocks fit in?

Goldilocks, for readers who skipped childhood, was walking in the forest when she came upon a little house whose occupants were not home. She entered the house and tried out the food and furniture belonging to Papa Bear, Mama Bear and Baby Bear. In each case, she found two of the three options to be too extreme, and one to be just right. One bowl of porridge, for example, was too hot, one was too cold and one was just right. One bed was too hard, one too soft, and one just right.

You may be better served by adopting Goldilocks' approach to evaluating your options when you deal with the health care system, rather than accepting the Santa Claus assumption.

Research shows that too little health care is bad for your health. That's easy to understand. Research also shows that too much health care is bad for your health. That's harder to understand. But side effects and complications injure or kill thousands of people every day of the week. You may find that you get better results by focusing on getting care that is "just right." That means getting enough care, but not too much. It means focusing on getting care that's a good fit for you and your life.

Standing with Goldilocks may not seem like a very appealing choice, at first glance. On one hand there is Santa Claus: cheerful, friendly, giving away free gifts. (Although there is that tiny, niggling concern about "batteries not included" and other fine print. Sometimes the gifts don't provide the intended benefits, for one reason or another, even if they sound terrific.)

On the other hand there is a little girl (where are her parents?!) who has broken into a house, who has used other people's belongings without their permission, and who is, to be frank, a little whiny -- two-thirds of what she tries out, she rejects as not up to her standards. Who asked for her opinion, anyway?

Consider Goldilocks' experience a little further, though. She has somehow found herself in a dangerous situation -- alone in the forest where shadows threaten and where it is hard to tell friend from foe. It is not her turf. Nothing is familiar. When she knocks on the door, looking for help, no one answers. She's on her own. And the residents of the home she enters could show up at any moment and bite her head off. Literally.

She isn't viewed as a frightened visitor who needs care. She's viewed with suspicion. She's seen as an outsider, a trespasser, an interloper. No one asks her how she came to be there, or what she needs. When she found a chair that was comfortable to sit in, it broke beneath her. This problem is viewed as her fault. No one suggests that perhaps something was wrong with the chair. She is seen as a disruption to the smooth running of the household.

When you enter the health care system, does it feel as though you are in scary foreign territory? Does it seem as if assumptions about your role as an outsider may work against you? Perhaps you have more in common with Goldilocks than you might think at first glance. Perhaps it might serve you well to check out the options available to you, and to choose ones that are "just right" for you. And leave Santa Claus to Christmas.

(Editor's note: The four examples the author gives from Health Affairs are supported by information she gleaned from other studies.)