Health Care at Risk

In Health Care at Risk Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality problems afflicting the American health care system. The idea behind CDHC is simple: consumers should be encouraged to save for medical care with health savings accounts, rely on these accounts to cover routine medical expenses, and turn to insurance only to cover catastrophic medical events. Advocates of consumer-driven health care believe that if consumers are spending their own money on medical care, they will purchase only services with real value to them. Jost contends that supporters of CDHC rely on oversimplified ideas about health care, health care systems, economics, and human nature. In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

“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, “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 , “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]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.”

Timothy Stoltzfus Jost is the Robert L. Willett Family Professor of Law at the Washington and Lee University School of Law. He is the author of Health Care Coverage Determinations: An International Comparative Study and Disentitlement? The Threats Facing Our Public Health-Care Programs and a Rights-Based Response. He is the editor of Readings in Comparative Health Law and Bioethics and a coauthor of Health Law: Cases, Materials, and Problems, now in its fifth edition.