Understanding Hobson’s Choice in Healthcare

Posted on September 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

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Hobson’s Choice in Medicine

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Hobson’s choice is a free choice in which only one thing is actually offered. The term is often used to describe an illusion that choices are available. The best known example is “I’ll give you a choice: Take it or leave it”, wherein “leaving it” is strongly undesirable.

The phrase is said to have originated with Thomas Hobson (1544–1631), a livery stable owner in Cambridge, England, who offered customers the choice of either taking the horse in the stall nearest to the door or taking none at all.

A CASE MODEL

Half of Physicians Plan to Change Career Paths

The Physicians Foundation recently conducted a survey on physician practice patterns and perspectives. Here are some key findings from the report:

• 31% of physicians identify as independent practice owners or partners.
• Almost half (47%) of physicians plan to change career paths.
• 78% of physicians sometimes, often or always experience feelings of burnout.
• Nearly a quarter of physician time is spent on non-clinical paperwork.

This result is not a good Hobson’s Choice in Medicine.

Cite: The Physicians Foundation, September 2018

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LONG TERM CARE INSURANCE: A Hobson’s Choice Decision?

Posted on May 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Long Term Care Insurance [LTCI]

Some retired people live on a fixed income and many of them live right on the edge of their financial capability.  At some time in their life, they may have to make a choice regarding many purchases.  

In this case, we will illustrate “choice” using a couple’s purchase of Long-Term-Care Insurance [LTCI]. Of course, economics is the study of choice; wants, needs and scarcity, etc. In our case, if they decide to make the purchase they commit to a lifetime of premium payments. The financial tradeoff is this; if they make the commitment to purchase LTCI, they must give up something else.

EXAMPLE: In order to maintain a monthly premium of $100 ($1,200per year), an elderly patient, retired layman or couple must essentially relegate about $30,000 of financial assets to generate the $100 necessary to make an average premium payment (assumes a 7% rate of return with 4% withdrawal rate) or [4% X $30,000 = $1,200 year]. Thus, if the monthly premium cost is $500 per month, the elder must give up the use of $150,000 of retirement asset just to generate enough cash flow to pay for the LTC insurance. 

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The married elder couple has to make the Hobson’s Choice decision among lifestyle (dinners, vacations, gifts to children, prescription drugs, medical care or food and shelter) versus paying an insurance premium to provide for nursing home coverage for a need, which may be very real, but will not occur until sometime in the ambiguous future. 

And so, when faced with such a tough economics Hobson’s Medicine Choice, neither of which delivers peace of mind or a respectable solution; many will simply decide that, in either case, they may already end up impoverished. Thus, many will often opt for the better lifestyle now … while they can enjoy it … together. 

Cite: Anonymous Health Insurance Agent, Norcross, Georgia

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Filed under: "Ask-an-Advisor", Alternative Investments, Career Development, CMP Program, Drugs and Pharma, Ethics, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Retirement and Benefits | Tagged: , , , , , , , , , , , , | Leave a comment »

MORTON’S FORK: A Hobson’s Choice & Paradox

Posted on March 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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A Morton’s fork is a type of false dilemma in which contradictory observations lead to the same conclusion.

Morton’s Fork: Claims its origin from John Morton, the Archbishop of Canterbury, a public policymaker who used convoluted and contradictory logic to establish tax laws in the mid-15th century.

He contended that whoever lived humbly must be saving much money and hence would be able to pay higher taxes; and those that lived lavish lives were obviously rich, so they could also pay higher taxes.

In other words: a Hobsons Choice between two equally unpleasant alternatives.

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MEDICAL PROVIDERS: Hobson’s Choice in Medicine

Posted on January 4, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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TUCSON, Ariz., Dec. 06, 2022 (GLOBE NEWSWIRE) — Sheila Page, D.O., a family physician in Aledo, Texas, and president of the Association of American Physicians and Surgeons (AAPS), is featured in the winter issue of the of the Journal of American Physicians and Surgeons. She writes:  “Today physicians often feel constrained to pick from among options that are not in the best interest of patients but are ‘covered’ by insurance or approved by officials.”

“An apparently free choice when there is no real alternative is a Hobson’s Choice, and physicians must understand the political structure in which this type of ‘choice’ is embedded,” Dr. Page explains.

“During the COVID pandemic, people often faced a Hobson’s Choice of taking a shot that they believed put their life, health, or fertility at risk, or be barred from their education or career,” she noted.

“Voters generally believe that they have two choices, Republican or Democrat, and that they represent extremes of political ideology. However, when they are in office, politicians behave as if they belong to the same club,” she writes.

“Physicians have accepted the Hobson’s Choice of either abiding by ridiculous regulatory burdens or refusing to treat the senior population,” she explains. They “accept the Hobson’s Choice of either standing against the oppression or keeping their ‘place at the table.'” 

“The phrase ‘we need to keep our place at the table to avoid being on the menu’ entirely misses the point,” she states. “The profession is on the table already being carved up. How many times have we been told we must choose the lesser of two evils? Either choice is still evil!”

“We must identify the enemy within,” Dr. Page writes. “The medical profession must grasp the extent to which it has been manipulated by pharmaceutical, insurance, and other systems tied to medicine. We have been burdened with regulations and threats to our licenses by the same people who are selling us the solutions.”

“There is tremendous profit in the existing system, but we must nevertheless offer healing and hope, learn how to fight back effectively, and reject the Hobson’s Choice,” she concludes.

CITE: The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

CITE: https://www.r2library.com/Resource/Title/082610254

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Understanding Hobson’s Choice in Medicine

Posted on January 10, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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Hobson’s choice  in Public Health

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By Dr. David Edward Marcinko MBA

[From Wikipedia, the free encyclopedia]

A Hobson’s choice is a free choice in which only one thing is offered. Because a person may refuse to accept what is offered, the two options are taking it or taking nothing. In other words, one may “take it or leave it.”

The phrase is said to have originated with Thomas Hobson (1544–1631), a livery stable owner in Cambridge, England, who offered customers the choice of either taking the horse in his stall nearest the door or taking none at all.

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An oil portrait of Thomas Hobson, in the National Portrait Gallery, London. He looks straight to the artist and is dressed in typical Tudor dress, with a heavy coat, a ruff, and tie tails

[Thomas Hobson, the National Portrait Gallery, London]

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In Medicine

One of the first examples that springs readily to mind in trying to look for examples of Hobson’s Choice in Medicine is the issue of defensive medicine. While the physician actually has the option of not “shotgunning” a patient (that is, shooting randomly large number of tests in order to cover legal liability and prevent medicolegal backlashes), the risk of missing a diagnosis and the fall outs thereof are so large, that it basically degenerates into a Hobson’s Choice.

The idiosyncrasies of medicine and the way the body reacts to them always leaves us open to the risk of working within the constraints of Hobson’s Choice.

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pills+capsules+other

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For example, antibiotics have saved more lives than we can count, yet, an idiosyncratic, unpredictable reaction may just be waiting for us around the corner.

In Public Health

In the Indian Public Health scenario, all that the patients are offered in a primarily paternalistic system is the choice Hobson had offered all those years ago. Much like Henry Ford, who told customers lining up to buy his revolutionary Ford Model T that they could have their cars in “any color so long as it is black”, the Indian system, hobbled by the lack of an empowered public, and a patient choice scheme, functions on the basis of Hobson’s choice.

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Assessment

Even in the clinical sciences, with shared decision making and user driven healthcare still in their infancy in the nation, a paternalistic physician offers naught but “this or none” choice to their patients. While one can say that the lack of general awareness of the public tends to spawn this issue, we cannot shake off our personal stake in this matter just by hiding behind the façade of moral determinism!

Conclusion

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Financial Advisory Reform Going Down in Flames

Posted on April 10, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A [False] Hobson’s Choice*

By Staff Reporters

In political Washington DC, according to Ian Salisbury, almost anything will fly if you can make an argument it will benefit the middle class. It worked in the fight against requiring advisors to act in clients’ best interests … Say what?

Is this the case of a classic Hobson’s choice?

[picapp align=”none” wrap=”false” link=”term=bank+reform&iid=8227139″ src=”c/3/0/3/Sen_Dodd_Discusses_655e.jpg?adImageId=12270785&imageId=8227139″ width=”380″ height=”570″ /]

The Strategy

Yep, its true! At least, this strategy worked for the National Association of Insurance and Financial Advisors [NAIFA], which fought a recent proposal that would have made all financial advisors act in clients’ best interests … you know – the “F” word.

Assessment

It seems that there are few protections for the public from unscrupulous FAs, stockbrokers, and insurance agents. And, few wish to become fiduciaries.

http://www.fa-mag.com/online-extras/5406-a-phony-argument.html

*A Hobson’s choice is a free, usually economic, choice in which only one option is offered.

Conclusion

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