For consumers to incorporate price into decisions to buy health care, they must pay directly for more of their own care, and they must also personally gain from paying less. Motivation by patients to consciously seek value and save money is the essential lever to force competition among health care providers.

One critical piece of the puzzle is widely available high deductible insurance plans (HDHPs). Higher deductibles necessitate direct patient payment for care up to the deductible. A second highly effective tool to motivate patients to consider price is large, liberalized health savings accounts (HSAs). These tax-sheltered accounts grow by contribution or investment and are generally used to pay for non-catastrophic expenses, which form the bulk of medical care. Better than tax deductions, HSAs introduce something unique--they incentivize saving.

The data reinforces that large HSAs with HDHPs motivate patients to consider prices more than they otherwise would. The spending of patients with HDHPs paired with HSAs decreased at least 15% annually, according to a March 2015 study. When people have savings to protect in HSAs, the cost of care comes down without harmful impact on health. More than one-third of the savings by enrollees in such coverage reflected value-based decision-making by consumers. According to a Health Affairs report, system-wide health expenditures would fall by an estimated $57 billion per year if even half of Americans with employer-sponsored insurance enrolled in plans combining HSAs with high deductibles.

HDHP premiums are typically less expensive, but ACA regulations counterproductively raised their premiums and limited their availability. My analysis of Employer Health Benefits Annual Survey data shows that premiums for HDHPs rose from two to five times faster than premium increases for any other type of coverage after ACA passage. Excessive coverage mandates that make HDHPs more expensive should be rolled back--including Obamacare's "essential benefits" that increased premiums by almost 10%, and the 2,270 state coverage mandates for everything from acupuncture to marriage therapy. To make HDHPs even more affordable, we should remove the ACA's 3:1 age rating that raised premiums for younger enrollees by 19-35%, many of whom would buy lower premium coverage.

To maximally drive down the price of care, HSAs should be available to all Americans, including seniors on Medicare, given that seniors are the biggest users of health care. Because life expectancy from age 65 has increased by 25% since 1972, today's seniors need to save for decades of future health care. Raising maximum contributions at least to those of IRA limits is one important step, as well as permitting tax-sheltered rollovers to surviving family members. HSA payments should also be allowed for the expenses of the holder's elderly parents.

The visibility of information that patients require for assessing value must also be radically improved.  Data from magnetic resonance imaging (MRI) and outpatient surgery show that introducing price transparency encourages price comparisons by patients. Patients also need to have adequate information to assess quality, such as doctor qualifications and experience. The most compelling motivation for doctors and hospitals to post prices and qualifications would be their understanding that they are suddenly competing for price-conscious patients empowered with control of their money.