Document Type



You won't hear many health experts claim that the American
healthcare system is functioning perfectly in terms of core considerations
such as cost, access, and quality. The question that arises with
the advent of any new policy approach seeking to improve the system
is obvious: Does the change represent a step forward or backward?
Professors Kristin Madison and Peter Jacobson take up this question in
regard to the latest innovation in health care policy­consumer-directed
healthcare (CDHC).

Professor Madison argues that while CDHC is not a panacea,
"[e]ven if its shortcomings prevent its full diffusion through the
American health care system, CDHC will still . . . help[] to establish a
foundation for future reforms in health care finance and delivery,
[and] has the potential to improve the health care system in the long
run." Professor Jacobson's response? "CDHC is a direct attack on the
idea that health care differs from other market commodities because
of its moral aspirations . . . . For those who believe that equity should
be a fundamental attribute of health care delivery, CDHC represents a
huge step backwards." Nonetheless, Professor Madison is convinced
that CDHC will be a lightning rod that stirs the American health care
system out of its complacency and "forces us to confront the tradeoffs
inherent in any health care system in a resource-constrained world."
Professor Jacobson is not content to wait and see how the American
public reacts to CDHC: "If the policy focus is on CDHC, equity will be
subordinated. If universal coverage dominates, CDHC proponents
are probably right that cost and quality issues will be subordinate. For
me, it's an easy choice­helping those without insurance to have a
minimal acceptable level of care."

Date of Authorship for this Version



consumer-directed health care, CDHC, Health Law

Original Citation

Citation: Kristin Madison & Peter D. Jacobson, Debate, Consumer-
Directed Health Care, 156 U. PA. L. REV. PENNUMBRA 107 (2007),, Copyright 2007 University of Pennsylvania Law Review.