Patient Rage
Consumers march to the walls of the health-care castle.

by DANIEL HENNINGER
Friday, January 30, 2004 12:01 A.M. EST

Believe it or not, everyone in America does not use Medicare. For years, the public-policy debate has so obsessed over "Medicare," "prescription-drug benefit" and "the uninsured" that one might think the whole country was either enrolled in Medicare, or not insured. Medicare as an interesting subject vanished long ago into the Washington flytrap and is mainly about "expenditures," not health care. Most of the country's laying on of hands in fact flows through corporations, for people who are working and raising families. This is where the real action, excitement and potential for improving health-care delivery in the U.S. lies, not in the Medicare "debate."

Earlier this week The Wall Street Journal partnered with World Congress and CNBC to sponsor a conference in Washington on private-sector health, which appears in the news, if at all, as a "cost-driver"--rarely about the real people in the plans (normally called "populations"). Speakers scanned the spectrum from Milton Friedman to Sen. Hillary Clinton.

Much of the talk was about explosions. Typically, "health-care costs are exploding." Employers fear they'll be buried in the rubble of health costs, now rising at some 15% annually. But other, brighter explosions are also in health's firmament--in genomics (perhaps allowing predictions about individual illness and therapies tailored to individuals); or in information technology (remote medical sensors, implanted monitors, Web-based health-care "wizards"). News arrives weekly of miracles springing from the minds of the U.S.'s remarkable medical scientists.

George Metzger of Textron said the Rhode Island-based manufacturing conglomerate was "driving our employees nuts" with cheap fixes and a plan that was too complicated. "Year after year," he said, "nickel-and-dime cost-sharing increases diminished benefit value." In 2002 Textron offered one of those new "consumer-directed" plans that puts more responsibility for financial control and health decisions onto employees. Money put in employee accounts can be rolled forward annually. Mr. Metzger says Textron still has to "manage" the plan but that the employees who chose it have been positive in response; it has "refuted all the myths" about such plans.

Laurel Douty told a similar story about the Baylor Health Care System, which adopted a higher deductible, consumer-directed plan with a year-to-year financial rollover for its own workers, "many of them single mothers." A spokeswoman from American Century, the investment management firm, described their commitment to a similar plan that puts a greater decision burden on workers.

All of the new plans provided tools that let employees access health information of a sort they'd never seen before. That included both Web-based programs and human "coaches" who give guidance on dealing with chronic aliments or complex medical problems. Dr. Paul Tang of the Palo Alto (Calif.) Medical Foundation gave an extensive tour of its Web-based program, PAMFOnline, to interact with doctors, renew prescriptions and track one's health care. Take my word; if you saw it, you'd want it. And--if you were a patient--most likely, you'd want what Textron, Baylor and American Century has.

This adds up to an excuse for doing nothing, or not much that taps the potential of modern medicine. It is a rationale for turning over the future of our health care to what Milton Friedman calls "the technicians," a vast network of professors and specialists whom foundations pay to concoct recurring patches to Medicare and the health-care "system." System? This vast complexity of humanity, science and money is considered a "system" only because it has been tethered for 50 years to the tax code and is therefore ultimately answerable to oversight by public bureaucracies.

Mr. Henninger is deputy editor of The Wall Street Journal's editorial page. His column appears Fridays in the Journal and on OpinionJournal.com.