Health Savings Accounts: Putting Patients in Control

"The premise in those kind of questions … are that people are stupid. They're not smart enough to make these decisions for themselves. It's sort of an elitist attitude," Mackey said. "The individual is the best judge of what's right for the individual."

Shopping Around

Apparently, most individuals are making smart choices.

Regina Herzlinger, a Harvard Business School professor and author of "Who Killed Health Care?," said that "people who have these high-deductible health-insurance policies take better care of themselves. … They have more yearly physicals," she said. "Because they're saying, if I keep myself healthy, in the long run, I'm gonna be spending less money."

Whole Foods employee Cheralyn Schmidt used her account when she wanted to get a physical. Because it was her money, she shopped around. She found prices varied by hundreds of dollars.

"If I had regular insurance, I would have never called around and asked for prices," she said. "I would have just walked in, showed my card, said, 'I need a physical,' … and I don't even really know what they would have given me."

The fact that she was paying changed the way she thought about that physical.

"I started thinking, 'Well, what I am getting for this price? For $1,200 what I am getting?'" she said.

Grace-Marie Turner of the Galen Institute, which studies free-market solutions to health-care problems, said doctors don't often know what to say when patients like Schmidt ask them what things cost.

"I mean, that shows you how dysfunctional our health-care system is," Turner said. "That people don't have the vaguest idea how much they're spending on health care, close to the closest $10,000 or $20,000, often, when they go to the hospital. And the sellers don't have any idea what it costs."

Competition forces Whole Foods to pay attention to prices. "We know what [Texas supermarket chain] H-E-B is selling broccoli for right now, so we have to reflect our prices to the competition," Mackey said. But in health care, "No one's trying to think, 'Yeah I'm going to cut 5 percent below that price, so I can increase my business.'"

Creating Competition

But some say health care's different. It's too complex. We can't decide that.

"Gosh," Mackey said. "You know, should we allow people to make decisions about whether they have children or not? I mean that's a pretty important responsibility, having children!"

But what about the argument that people don't know anything about things like cancer treatments?

"I don't know anything about cars," Mackey said. "[But] if I go buy a Toyota, or an Audi, or a Lexus, I know I'm going to get a pretty good automobile, because competition ensures that it will be that way."

That is why Americans buy Toyotas instead of Trabants. Of course cars and cancer are different, but where there is competition, information resources like Consumer Reports and Web sites spring up to help consumers make decisions. As the sliver of competition has entered health care, similar resources have appeared, rating doctors and hospitals.

Ingenix, a health-care information and technology company based in Minnesota, has developed software that analyzes data from insurance claims to rate doctors and hospitals on quality and price. The firm has found that doctors that rate higher in quality tend to cost less money. They also catch problems earlier and keep their patients out of the emergency room more often.

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