Why doesn't Dr. Jones' opinion about therapeutic efficacy really matter? What if the patient won't or can't take the test or medicine?

Why, in the calculus of health care quality assessment isn't medication compliance, affordability, taste, frequency of dosing, or even opportunity costs* taken into account when insurance companies decide what to pay for or to cost-share? For that matter why don't these issues weigh in on public policy and health-care reform?

* Mom having to miss work, Sally suffering longer and possibly needing to miss school for a longer period of time

"The Health Insurance Disconnect" –  Originally published Monday, October 13, 2008