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The U.S. spends more on health care than other countries. In 2003, it accounted for 15.3% of the gross domestic product, a greater percentage than Germany, France, Japan, Italy, Canada, and other developed countries spend to cover all their citizens. What we are getting in return is a second rate health care system, according to Donald L. Barlett and James B. Steele, investigative reporters, formerly at the Philadelphia Inquirer and now editors at large for Time magazine. What kind of a health care system, they ask, leaves 44 million people without health insurance and tens of millions more underinsured?

One of America’s cherished myths is that uninsured people eventually get health care when necessary. Yes, if they are sick enough, say Barlett and Steele, but they will be discharged from the hospital sooner than insured people, often over their doctors’ protests. Shockingly, hospitals typically charge non-insured people five to ten times what an insured person would pay for the same services. With people who don’t earn enough to pay an astronomical bill, hospitals can play hardball. Non-profit and for-profit hospitals alike have been known to sue, garnish wages, and take away assets, such as a house. A catastrophic accident or illness can bankrupt even the insured. Almost no one knows what their health insurance pays until it’s too late. Unlike citizens in countries with universal health care, insured Americans spend countless hours filling out forms and questioning incomprehensible bills.

For the last two decades, politicians have sold the American public on the idea that the free market system is the best way to deliver health care. But health care has always proven to be remarkably resistant to a free market system that thrives on selling more and more. That’s the last thing a medical care system needs, wrote the authors, who see the goal as fewer hospitalizations, fewer consultations with specialists, fewer diagnostic tests, and fewer prescription drugs.

Over the next few years, the voice of the consumer will rapidly become what the Japanese call “The Voice of the Crane,” a clarion that rings across the landscape and forces all to attend.

Like many health care innovations, consumer-focused health care will sweep first and most powerfully through the United States’ fractious and chaotic system, but it will not be neatly contained there. It will influence other national systems–especially if it lives up to its promise.

The promise is itself not simple. It is an attempt to enlist American’s determination to get good value for their money–and their frustration at both the ever-larger scoops that health care is taking out of their pockets, and their sense that they have no control or even influence on the process–in the effort to control health care costs.

Consumer-directed health plans (CDHPs) come in several varieties, but the essence is a combination of a high-deductible insurance plan to take care of serious problems, with a pot of money (provided by the employer, or both the employee and the employer) for everyday needs.