Assessing and critiquing the ability of consumer-driven approaches to fix the problems in the US health care system.

In Health Care at Risk Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality problems afflicting the American health care system. The idea behind CDHC is simple: consumers should be encouraged to save for medical care with health savings accounts, rely on these accounts to cover routine medical expenses, and turn to insurance only to cover catastrophic medical events. Advocates of consumer-driven health care believe that if consumers are spending their own money on medical care, they will purchase only services with real value to them. Jost contends that supporters of CDHC rely on oversimplified ideas about health care, health care systems, economics, and human nature.

In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

"“[A]n analytic tour de force, comprehensive in scope, scrupulous in scholarship, balanced in approach, and incisive in its policy recommendations. . . . Health Care at Risk is a fine piece of work that should be of interest to policy makers, policy researchers, and many physicians. It would also be an excellent supplementary text for an introductory course in health policy and management. Name an issue that is germane to the current health policy debate and you are likely to find it discussed here. The references and footnotes are comprehensive and meticulous. Most of the major modern contributors to health care organization and finance are not only cited, but their ideas are transmitted with high fidelity and clarity.”" - JAMA