“You may call me a cockeyed optimist,” said Dr. Rex Cowdry, Associate Director of the White House National Economic Council, “but I think we truly can see significant improvements in U.S. health care in the near future."

In his keynote speech at the Consumer-Directed Health conference, Cowdry predicted radical differences in health care within one decade, describing a transformation to a responsive, “patient-centered, provider-friendly, information-rich” system that remains competitive and market-based. Consumerism is the driving force behind this vision, which has arisen rapidly in the industry in response to recent government regulations and increasing economic pressures.

When patients have economic incentives for preventive care — Cowdry specified first-dollar coverage for preventive services — their overall health will improve, enabling them and their employers to avoid many of the cost pitfalls and health catastrophes that stem from poor disease management and unhealthy lifestyles.

Likewise, Cowdry expects consumerism to create price transparency in the health care industry. As consumer-driven plans demand that patients know the true costs of their health-related decisions, patients will have a financial reason to seek more information — and accountability — from providers.

For the new system to work, Cowdry stressed, it must be perceived as fair. He mentioned the need for a transformation in public financing to assist the poor, the unemployed, the self-employed and other groups who typically face special health-insurance challenges.

He also suggested creating tax credits and purchasing pools for lower-income groups, which would effectively allow those groups to participate in health care consumerism instead of forcing them to accept a single national plan.

Cowdry, a former doctor and research administrator, described his own experiences as a patient as representative of health care’s current inefficiency. “We must get rid of the clipboard,” he said, citing the widespread practice of requiring patients to repeatedly give the same information to health care providers.

Conversely, said Cowdry, although paper-based systems are inefficient, a doctor who has only a 15-minute encounter with a patient needs not to waste time searching for records.

What will replace the clipboard, Cowdry suggested, is integrated information technology. His ideal system would combine the ability to share data with patient privacy. For the sake of security it would lack a central data repository, but it would allow providers to access a far broader spectrum of medical information than they can today. And, though the system would be integrated, integration would not start at the top and move down.

In Cowdry’s theoretical system, patients’ personal information would reside only with the institutions responsible for their care, though patients could download medical records to their personal computers. The system would automatically alert providers to patients’ health risks, telling a doctor, for example, that someone is overdue for a blood-lipid test.

At the same time, the system would allow providers and institutions to exchange anonymous data (that is, with patients’ identifying details removed) in order to track real-world treatment outcomes, geographical and demographic trends, and other factors that might improve care for others.

The right kinds of incentives, said Cowdry, will drive such technological innovation. When consumerism links providers’ pay to their performance — and enables patients to seek care elsewhere — providers will demand a system that works.

Of course, any system has problems. Cowdry cited unequal rural hospital markets, education and covering the un- and under-insured as particular challenges for consumer-driven health.

He further cautioned that true change will have to evolve from market pressures. The government, he noted, isn’t better than private insurers at cost control; it’s less responsive to new technology and individual choice. But a consumer-driven system will “let value triumph over special interests.”

Above all, said Cowdry, to succeed, consumerism must focus on the patient. “The system should have one true north,” he said, quoting Don Berwick, president of the Institute for Healthcare Improvement, “and that true north is the experience of the patient going through the health care system.”