The Internal Revenue Service recently ruled all employers, regardless of size, can adopt a medical savings account–type program as part of an employee benefit package. This frees all employers to adopt a version of a consumer-driven health plan as part of their benefit package. This could continue a trend toward consumer-driven health insurance that began with the Health Insurance Portability and Accountability Act of 1996. The authors review current health insurance problems, including a discussion of competitive market and insurance theory. The medical savings account experiment is summarized, including pros, cons, politics, and theory. Finally, the authors briefly review the theory of agency and conclude with a call for nursing to fill this niche quickly for the good of our patients.

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