According to Wikipedia and our companion crowd-sourced initiative the Health Dictionary Series® http://www.HealthDictionarySeries.org, a Hobson’s choice is a fee 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 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.

Thomas Hobson (1544-1631)

Thomas Hobson, who gives the name to this dicey doozy, was a mail carrier, who delivered mail between London and Cambridge and hence was known as the Cambridge Carrier. He also operated a livery stable (that is a kind of equestrian facility where the horse owners pay a fee to keep their horses) just outside the gates of St. Catherine’s College, Cambridge.

NPG 1972, Thomas Hobson

[Thomas Hobson]

[Image Credits: National Portrait Gallery via Wikimedia]

When he was not riding his horses to deliver the mail, Hobson would rent them out to the students and teachers of the College. He soon realized that the best and fastest of his horses were invariably being chosen in the off-work hours. To prevent them from exhaustion and overuse, he devised a clever ploy, that is known as Hobson’s Choice!

In order to prevent his horses from being overused, Hobson gave the renters the choice that they could either have the horse that stood closest to the door, or have none at all. What it actually meant was that he offered no choice in reality. This was either one or none, which meant that one had to take up whatever was on offer. The term, “Hobson’s Choice”, did not appear into literary use till almost a century after his death.


Sophie’s Choice: Based on the choice Sophie, a movie protagonist played by M. Streep, had to make when put into a concentration camp by the Nazi Germans. She was asked which one of her two children would live and  which one she would choose to send to the gas chambers.

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.

Other Expressions: Many colloquial expressions exist where one has to choose from between two undesirable variables. Expressions like catch-22, dilemma, caught between the horns of a dilemma, and at sixes and sevens may exemplify this form of choice. This is not the case in Hobson’s Choice, which as previously stated, is not even a choice.


1. Hobson’s Choice Decision Example for … Patients

Even in the clinical sciences, with shared decision making and user driven healthcare still in their infancy in the USA, 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!

 2. Hobson’s Choice Decision Example for … Payers and Third Parties

Most insurance plans and third parties payers use a drug formulary. A drug formulary is a list of prescription drugs, both generic and brand name, that may offer both clinical and economic value. A committee of physicians and pharmacists usually maintain the formulary. Drugs considered for the formulary are evaluated by a payer committee of experts and are chosen for their safety and effectiveness. Clinical expertise and input may also sought from other physicians who are not insurance plan committee members. The formulary, pre-service authorization parameters, and related procedures are updated as needed when new information becomes available. Yet, drug formularies are becoming increasingly restricted and limited. Of course, some brand-name drugs may be more efficacious, regardless of cost. And, some patients may be allergic or sensitive to certain generic drugs; as well.

3. Hobson’s Choice Decision Example for … Providers

One of the first examples that springs readily to mind in trying to look for examples of Hobson’s Choice for medical providers is the issue of defensive medicine. While the physician actually has the option of not “shot gunning” a patient (that is, shooting randomly large number of tests in order to cover legal liability and prevent medico-legal 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.

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

4. Hobson’s Choice Decision Example for … Public Policymakers

In the the PP-ACA, federal government, Prison Health and/or Indian Public Health scenario, patients are offered in a primarily paternalistic system, the choice Hobson offered 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 public health policymaker system, hobbled by the lack of an empowered public, and a patient choice scheme, functions on the basis of Hobson’s choice.



[Harvesting the Power of Patients, Providers, Payers and Policymakers … for the Public Good]



According to the Health Dictionary Series®, Crowd-Sourcing is an online, distributed, problem-solving, and POWERFUL production model that uses the collective intelligence of networked communities for specific purposes. Although its use has benefited many sectors of society, it has yet to be fully realized as a method for improving medical care in the USA: http://www.HealthDictionarySeries.org

Four discrete Crowd-Sourcing approaches are used in this Hobson’s Choice in Medicine Project: (1. knowledge discovery and management; 2. distributed human intelligence tasking; 3. broadcast search; and 4. peer-vetted creative production types).


DISCLAIMER: All information written, curated and aggregated and/or listed on this  site is intended for general use and does not represent the thoughts, ideas or opinions of iMBA Inc., the Editors, Fayetteville State University or the School of Business and Economics. We offer no warranties, expressed or implied, and are not responsible for errors, omissions or consequences from the application of this information. Further- more, all accepted submissions may be reformatted and re-styled, and become the  property of iMBA, Inc. Submission does not guarantee inclusion on this website or printed textbook. The healthcare 2.0 ecosystem is evolving rapidly and all information should be considered time-sensitive. Always remember “Cogito Potestas Est” [Thinking & Learning is Power].

FREE SOFTWARE AND WEBSITE MOVEMENT: A philosophy that began in 1983 when Richard Stallman announced the GNU project, and the Free Software Foundation, in 1985 to support the movement. Its philosophy is to give freedom to computer users by replacing proprietary software under restrictive licensing terms with free software, with the ultimate goal of liberating everyone in cyberspace. Accordingly, use this website “at-your-own-risk“. We accept no “use” liability or merchantability for the site and are held-harmless in all matters.

ON INTERNET CITATIONS: The “crowd-sourced” online and curated hard-cover print version of: “HOBSON’S CHOICE IN MEDICINE” [Reflections on Decision-Making, Health Economics, Rationing and Free Enterprise] directs readers to useful internet sites with additional references. However, host entities frequently reorganize and update sites, so URLs can change rapidly. Citations for are therefore accurate when published, but we cannot guarantee how long they will remain so, despite our best efforts to keep them current and “live” on this website.


NOTE: © Copyright 2016-Present. Dr. David Edward Marcinko and the Institute of Medical Business Advisors, Inc. All rights reserved; USA. Trade marks, service marks and logos are property of their respective owners.



One thought on “ABOUT

  1. Did emotions kill “Economic Man”?

    According to Koen Smets, Homo economicus or Economic Man: rational, utility-maximizing and devoid of emotions, is seen as the antithesis of us ordinary humans who are full of emotions. But, is that really true?

    In this piece he argues that Economic Man relies just as much on emotion as we do: “rational” is not the opposite of “emotional”. Emotions are essential to make choices and for rational decision-making.

    More: https://medium.com/@koenfucius/did-emotions-kill-economic-man-72305bb4fe7c#.lz9jqu8s7

    Ann Miller RN MHA


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