They have developed a viable model that works; when you can assume risk for the sicker, older and poorer patients in the risk pool, guarantee outcomes and still make money; you’ve got something working right!

They have met the Deming test, i.e., they can describe what they do in a process, and therefore minimize the variation gremlin.

In my experience, “consumer directed health plans” generally have much larger deductibles that traditional group health coverage. The difference is hardly marginal.

Even one of the more notable private market HDHP proponents, Scott Shreeve, recently complained about obscene premium increases after years of not filing a claim.

To simply cost shift, i.e., have the patient or member essentially self insure does nothing to redesign the health care system. It merely shifts the financial burden. The literature has considerable accounts of needed medical care delayed if not withheld outright.

And the research I have seen published to date claim there is no quality differential, and that higher deductible amounts do not discourage access to needed care are preliminary at best, sponsored by the very plans that offer them, and were hedged with author commentary as not necessarily predictive per se.

Without systemic reform, so called consumer directed health care will be nothing more than a banner for private market special interests to carry. It will not serve a large percentage of Americans in need of care and/or covered access to services.