Preface  ix

1. Our Broken American Health Care System  1

2. The Consumer-Driven Prescription  17

3. Consumer-Driven Health Care Advocates: Who They Are and What They Believe  27

4. Consumer-Driven Health Care the First Time Around  42

5. The Nonaccidental System  54

6. The Origins of Consumer-Driven Health Care: A Short History of American Health Economics  

7. The Theoretical Foundations of Consumer-Driven Health Care  86

8. But Does It Work? The Evidence for and against Consumer-Driven Health Care  119

9. Legal, Ethical, and Regulatory Issues Presented by Consumer-Driven Health Care  150

10. Are Consumers Our Only Hope? How Other Countries Organize Their Health Care Systems  166

11. How to Fix Our Broken Health Care System: Where Do We Start?  189

Notes  205

Bibliography  225

Index  253

“[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.”—Richard L. Kravitz, Journal of the American Medical Association

“Jost’s arguments are fair, thorough, and convincing; his book is well written and well researched.” —Library Journal

“[A]nyone who wants to learn what the movement is all about should read this insightful book by the nation’s foremost expert on the subject.”—Jill Quadagno, Health Affairs

“Jost has written an insightful and very informative book on the strengths and limits of the CDHC approach to meeting the health care needs of the US. In a very readable and compelling style, Jost lays out the problems in the current health care system, defines the primary issues one must consider in building a health care financing system, and explores the history and solutions that CDHC offers . . . .The book is extensively referenced. It will be valuable as Americans search for a health care solution. Recommended.”—R. L. Jones, Choice

“This book is much more than an attack on the particulars of CDHC theory and policy, however. It is a broad-based critique of market theory and ideology generally. . . . Many of this book’s both broad and focused points of attack are already familiar to academic health policy audiences (e.g., adverse selection, favoring the rich and healthy), but several of Jost’s arguments and uncovered sources of evidence are novel or are exceptionally well stated and documented. Several chapters constitute important new contributions to the health policy literature, and the book as a whole is very well researched, written, and argued.”—Mark A. Hall, Journal of Health Politics, Policy, and Law

“Timothy Stoltzfus Jost has prepared an interesting and very readable book on a topic of widespread interest to policymakers, employers, health care providers, and academic researchers. . . .”—Anthony T. Lo Sasso, Inquiry

“Health Care at Risk should be of great interest to two groups of readers. Anyone who teaches health policy and politics should read it for its arguments about history and economics and its account of current ideas, and I suspect many who read it will consider adopting it for their courses. This book is a superb introduction to a large part of health policy. Yet it should be read more widely because it is the best work I have seen about one of the basic policy conflicts in American politics today.”—Joseph White, Perspectives on Politics

“[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.”—Richard L. Kravitz, Journal of the American Medical Association

“Jost’s arguments are fair, thorough, and convincing; his book is well written and well researched.” —Library Journal

“[A]nyone who wants to learn what the movement is all about should read this insightful book by the nation’s foremost expert on the subject.”—Jill Quadagno, Health Affairs

“Jost has written an insightful and very informative book on the strengths and limits of the CDHC approach to meeting the health care needs of the US. In a very readable and compelling style, Jost lays out the problems in the current health care system, defines the primary issues one must consider in building a health care financing system, and explores the history and solutions that CDHC offers . . . .The book is extensively referenced. It will be valuable as Americans search for a health care solution. Recommended.”—R. L. Jones, Choice

“This book is much more than an attack on the particulars of CDHC theory and policy, however. It is a broad-based critique of market theory and ideology generally. . . . Many of this book’s both broad and focused points of attack are already familiar to academic health policy audiences (e.g., adverse selection, favoring the rich and healthy), but several of Jost’s arguments and uncovered sources of evidence are novel or are exceptionally well stated and documented. Several chapters constitute important new contributions to the health policy literature, and the book as a whole is very well researched, written, and argued.”—Mark A. Hall, Journal of Health Politics, Policy, and Law

“Timothy Stoltzfus Jost has prepared an interesting and very readable book on a topic of widespread interest to policymakers, employers, health care providers, and academic researchers. . . .”—Anthony T. Lo Sasso, Inquiry

“Health Care at Risk should be of great interest to two groups of readers. Anyone who teaches health policy and politics should read it for its arguments about history and economics and its account of current ideas, and I suspect many who read it will consider adopting it for their courses. This book is a superb introduction to a large part of health policy. Yet it should be read more widely because it is the best work I have seen about one of the basic policy conflicts in American politics today.”—Joseph White, Perspectives on Politics

“Health Care at Risk is the first intelligent and intelligible discussion of a new fad in American health policy, the so-called ‘consumer-directed’ movement. This topic is quite important, and Timothy Stoltzfus Jost knows what he is talking about.”— Theodore R. Marmor, author of Fads, Fallacies, and Foolishness in Medical Care Management and Policy

“Health Care at Risk offers a scholarly and insightful assessment of the origins, theoretical underpinnings, and key elements of the modern consumerism movement in health care financing and its implications for health care access and quality. Clear, unbiased, and thought-provoking, Timothy Stoltzfus Jost’s book is essential reading for anyone concerned about the future of the American health care system.”—Sara Rosenbaum, Chair of the Department of Health Policy and Harold and Jane Hirsh Professor of Health Law and Policy, George Washington University School of Public Health and Health Services

“In Health Care at Risk, Timothy Stoltzfus Jost has written a compelling and yet balanced critique of the so-called ‘consumer-driven health care movement,’ a movement that is gaining force not just in the United States, but around the world. Students of international health policy, and indeed supporters and opponents of the CDHC movement, would benefit from reading Jost’s account.”—Adam Oliver, Editor in Chief, Health Economics, Policy and Law

“A well-timed, compelling study, written for experts but also, thankfully, understandable by ‘consumers.’ Timothy Stoltzfus Jost shows why leaving health care decisions to a free market cannot work, even in the United States, while also emphasizing the importance of consumer choice in future policy decisions. Erudite, clearly argued, engaging, and fair.”—Rosemary A. Stevens, author of The Public-Private Health Care State

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