Brian- I believe the cautions you and others raise regarding over-weighting the impacts of consumers on health care transformation are very worth noting and real. That said, the trends are: 1. Away from employer based insurance. 2. Toward downloading financial risks onto the shoulders of employees/consumers. 3. Toward emphasizing a heavy dose of personal responsibility in return for universal health coverage. 4. Away from employer paternalism and sharing personal health information (unless forced otherwise) with employers. 5.Toward personal health planning and multi-generational learning and connectivity. All of this appears invisible at the moment because we lack an effective, easy to access and use tool to advance customized and personalized individual and family health planning, and the proper financial incentives to foster use of a such a Lifespan Planning Record. But if we were to move toward a more universal system, where access required utilization of this required planning tool on the front end of services; and were it to be required that the people who care for the people must come to the consumer's platform rather then the other way around, things could change quite quickly. So while I agree that the current status-quo delivers an under-engaged health consumer populace, I would suggest that this is the result of a "system-less" system and the absense and under-powering of both a modern vision and modern software applications more then any inherent lack of interest among American individuals or families to advantage choices on behalf of reaching their full human potentials. Mike | 
