Many people purchase health insurance, but very few people take a look on their benefits. It creates long bills to pay for hospital room rent, operation theatre charges, nursing expenses and other related services. But of course, we patients aren’t the real customers; government funding of electronic records wouldn’t change that. It is important to ensure that quality services are provided at the hospital.\n\nWe can be condescending and heedless of the costs we impose on patients’ lives and bank accounts. It is fully supported that a patient’s financial need is not a barrier to health care. If Tier 1 functional outcomes improve, costs invariably go down. In general, people with health insurance tend to get help earlier, when it usually is less costly and more effective.\n\nTheir argument is the same one that’s been made before by regulated railroads, electric utilities, airlines, Ma Bell, and banks: new competitors, they say, are using their cost advantages to skim off the best customers; without those customers, the incumbents will no longer be able to subsidize essential services that no one can profitably provide to the public.\n\nThe law narrowed the yawning disparities in access to care, levied the taxes needed to pay for it, and measurably improved the health of tens of millions. Is this really a big problem for our health-care system? Nonetheless, the benefits of a consumer-centered approach—lower costs for better service—should have early and large dividends for all of us throughout the period of transition.\n\n(Chronic conditions with expected annual costs above some lower threshold would also be covered.) We might consider other mechanisms to keep total costs down: the plan could be required to pay out no more in any year than its available premiums, for instance, with premium increases limited to the general rate of inflation.