The ascendancy of the political paradigm as the primary mode of health care decision-making is a natural evolutionary reaction to the unrestrained market paradigm. Although a certain of political intrusion into the health care marketplace is both necessary and useful, it has the potential to unravel the efficiencies achieved by managed care. Overzealous intervention in the health care market in the name of "reform" may cause the health care decision-making pendulum to swing back to the provider paradigm, with its tendency to escalate health care costs and diminish access. One possible way to achieve decision-making equilibrium and and end the cycling of extremist mono-paradigmatic dominance is to inject into the provider-patient-payer triad a neutral third party, a fiduciary whose duty is to guard the best interests of the patient, to stand as an informed agent between the financially self interested provider and payer.