California could be the first demonstration of health reform's ability to improve a health care system. The state has a massive number of low-wage or self-employed workers (32 million) enrolled in high-deductible plans because they can't afford higher premiums.

As we reported before, analysts at UCLA are worried high out-of-pocket costs remain tied with a reluctance to seek care. They're also concerned the lower monthly premium is a risky trap that lures low-income individuals and families who could possibly face thousands of dollars in expenses if they have a health emergency. And the gamble gets even riskier when most participants don't have a health savings account to help with those costs.

These experts are banking on the state's new "Health Benefits Exchange" to ease the cost burden by capping out-of-pocket deductibles at $2,000 for individuals and $4,000 for families and offering subsidies for those with low incomes. And with health reform's requirement for free preventive care services, the state seems poised to develop a nicely woven system of reform and consumer responsibility.

However, at this point, it might be too early, and we're assuming too much. Just because it's stamped into law doesn't mean consumers will change. Will they truly become aware of the valuable services they can get at no cost? Do they know they could be eligible to receive help meeting their deductibles? And will they actually take responsibility for routine checkups or screenings that could save thousands in the long run?

When Michelle Obama championed free preventive care, lawmakers finally appeared to be breaking through insurer limitations and maybe now they could stabilize the root of rising health costs by allowing easier access to preventive measures. But like her childhood obesity campaign, it's a good theory with a flimsy execution.

Though we have power as consumers, our stubborn nation is in need of guidance. If the brokers and agents who advise on health plans won't do the job to educate their clients, there's always another federal task force ready to intervene. That is, if anyone is willing to listen.

Instant Insights /

Health reform&#039;s hurdle: the consumer

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Health reform's hurdle: the consumer