A pretty strong case against consumer directed care

I'm normally a proponent of unleashing American consumers' well-honed shopping skills in the health care industry, but I'm having difficulty reconciling that with a front page article in today's Wall Street Journal (Multiple Births Persist as Doctors Buck Guidelines.) In vitro fertilization is the ultimate consumer directed procedure. Patients generally pay out of pocket and there is excellent, publicly available information about the quality of clinics, including pregnancy rates and percentage of births that are singletons, twins, and triplets and above.And still, patients are making bad decisions that can have devastating medical, social, and financial consequences. In particular, patients push to have multiple embryos implanted, which leads to multiple births. Having triplets or quads sounds exciting, but the babies tend to be sick or disabled leading to hundreds of thousands of dollars or more of neonatal intensive care costs, and additional costs down the road. Even healthy triplets and quads place a major strain on family finances and marriages. Finally, the practice of "reduction," i.e., aborting one or more fetuses has the potential to undermine support for abortion in general.Some clinics achieve high pregnancy rates and a low rate of higher order multiples simultaneously, but on the whole patients don't seem to be seeking them out. Maybe it would make more sense for managed care companies to cover fertility treatments the way they cover other procedures. They could direct patients to clinics that combine high pregnancy rates with low multiple birth rates and also save on the neonatal intensive care that they are paying for now anyway. Perhaps consumers don't deserve to make these decisions.