Consumer-driven health care: answer to global competition or threat to social justice?

Health planning in the United States is rapidly approaching a fork in the policy road, with one direction leading the nation toward a universal plan with strong government involvement and the other direction strengthening existing market-based reforms and preserving a commercial health insurance industry. "Consumer-driven health care," a slogan that captures a range of market-based approaches to preserving patient choice and increasing cost savings, is most commonly implemented in the form of individual health savings accounts. These accounts are offered to employees as a means of increasing the cost sharing ofpersonal health care expenses. The author provides an overview of health insurance history and discusses some implications of abandoning earlier practices of risk pooling health care expenses across a wider community. Access and affordability issues connected with the adoption of a consumer-driven health care system in the United States are addressed. Parallels are drawn between the expansion of community-based insurance in the United States following World War II and social work's historic commitment to social justice and economic inclusion. Suggestions are made for social workers'involvement in health policy discourse and activism during this critical time ofnational reflection on universal versus market-based reforms for the U.S. health care system.