Is consumer-driven health care a good idea?(POINT / COUNTERPOINT)

It would benefit everyone in the end.

In a consumer-driven market, price goes down and quality goes up, even if the average consumer is not expert about that product. How does that happen?

Markets are shaped not by the average buyers, but the marginal ones, who are knowledgeable, assertive, and very interested. They are the ones who made computers and cars better and cheaper. Consumer-driven industries also have terrific information. When I want to buy a car, I read Consumer Reports to learn about safety and reliability. When I walk into the showroom, I already know the dealer's price. As a result of consumer involvement, we have widespread ownership of cars.

What about health care? Health care is not consumer driven; somebody else makes the selection on the patient's behalf. I know a lot about my car, but what do I know about the quality of the surgeon who would perform a mastectomy on me or the hospital in which she practices? What doesn't get measured doesn't get managed, and as a result, we have inflation and unknown quality.

We need more choice in health insurance in order to create competition. In turn, competition creates productivity.

Contrary to popular belief, consumer-driven health plans are not all about high-deductible insurance policies; they are about choices. They will offer consumers a wide variety of plans, including HMOs, PPOs, high-deductible plans, multiyear plans, and plans that reward people who improve and maintain their health. But the results of high-deductible plans are positive; they not only control costs, they also motivate more preventive care and better outcomes for the chronically ill.

Consumer-driven health care will also liberate health care providers. Remember that 20% of the health care users account for 80% of health care costs. So you will see health care "focused factories" that concentrate on the sick. Initially, they will focus by procedure or patient group, but more importantly, they will focus on diseases and disabilities. For instance, diabetes patients with numerous comorbidities really need a team to help manage their disease. In a consumer-driven health care system, the Henry Fords of health care will be motivated to organize teams that help these patients or address such underserved populations as African Americans who have sickle cell disease. Consumers will respond to insurance policies that offer these focused factories.