NEJM May 7, 2020
Donald W. Rucker, M.D.

Smartphones and electronic transparency have transformed our lives and the U.S. economy. Yet health care remains a stark exception. When health information is available, it tends to be accessible only in ways that bind patients to their current health care providers and insurance plans. Medical and cost information is far more helpful if patients can use it on their own terms, with tools of their own choosing. In the decades since the passage of the Stabilization Act of 1942 (a program designed to soften wartime wage controls) made health insurance benefits a pretax expenditure, Americans have become so thoroughly immersed in third-party payment schemes that a consumer-directed health care system is hard for us to imagine.

But both economic and...

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