The Cash Nexus

Courts and legislatures have labored for decades to protect patients\u27 choice of medical treatments, even though patients seize that gift less eagerly than lawmakers expect. Yet while courts have rushed to build the whited sepulchre of informed consent, they have fled from a related problem that patients actually yearn to solve and that actually can be ameliorated the plight of patients who perforce agree to a treatment before they know its costs and who receive a bill both unrelated to the treatment\u27s value and several times what an insured patient would pay. Increasingly, patients must be consumers in the medical marketplace. This frightens patients, and should. Medical bills can be as alarming and baffling as medical ailments. The costs of illness particularly medical bills--contribute to more than half the personal bankruptcies in the United States. Even insured patients may find themselves paying for uncovered services that can be both numerous and dear. Furthermore, managed care\u27s effort to subdue health costs by inducing doctors to save money has been badly battered, and the new cry is to give patients such inducements instead. Consumer-directed health care makes patients consumers by asking them to purchase insurance programs shrewdly and by using high deductibles (one to five thousand dollars) and health savings accounts to make them purchase specific treatments. In short, individually we must increasingly worry about buying care wisely, and nationally we must worry about our latest adventure in financing health care