Consumer-directed health care has received recent attention as a fundamentally new approach to organizing the financing and delivery of health care. Consumer-directed health care consists of tax-advantaged health savings accounts, coupled with high-deductible health plans, which theoretically would make consumers, paying much more out of their own pocket, more prudent in seeking health care services. Insurance would be relegated to true catastrophic expenses. As patients, having become consumers, become accustomed to shopping for health care services, they would focus more on quality and service, leading clinicians to become market responsive, improving the care they provide, and, in Herzlinger's vision,1 organizing into “focused factories,” actively competing for the business of increasingly savvy customers.