After all, if health care is commodified, the more you pay, the more you will get. And vice versa.

Chollet believes this is a dangerous, undemocratic trend. "We need to think about health care differently," she says. "It’s not a car, where if you can’t afford the luxury model, you settle for something less. In health care, if you’re sick and you have to take the cut-rate model, that could be a wrenching piece of news."

By putting the money in the consumers’ hands, they also might be less inclined to spend it on necessary care. "You’ll have fewer people going to the emergency room for a cold because it will cost them $100. That’s good," Reinhardt says. "But you’ll also have fewer people getting a routine colonoscopy, because it costs $1,000 out of pocket. That’s bad."

The worst part of this for Reinhardt and others is the role technology is playing. "IT is making the capacity to discriminate worse," says Chollet. "It’s frustrating."

Health-care CIOs are cognizant of these ethical issues. And they say they are trying to address them. Most of the new plans now try to separate "cross" services (hospital visits and emergency care) from "shield" services (doctor’s visits and preventative care). At Destiny, for instance, Goltz’s plan removes necessary outpatient procedures, hospital admissions and medications required for chronic illness from the savings account allowance. "Look," Goltz says, "you break your arm and need surgery, you’re not going to want to negotiate the best price with an anesthesiologist. There’s a certain point where health care shouldn’t be negotiated. But there are plenty of services where it must be."

What’s certain is that CIOs will continue to be part of the mix when it comes to health policy. "IT has been and will continue to be the largest part of our organization," says Anthony Miller, CEO of Definity, to whom Casurella reports. One of Definity’s customers is Textron, the parent company of Cessna Aircraft and Bell Helicopter.

Miller says the central role IT plays in his company’s product has had an unintended benefit: staff retention. When IT workers feel crucial, they tend to stick around. Definity has lost only two IT staffers in two years. "Having [Casurella] at the table is not a question for us," Miller adds. "It’s a necessity."

"Traditionally, the CIO’s role in health care was supportive, reactive," Goodman says. "This is the most exciting opportunity for CIOs I’ve ever seen. We’ve slowly moved out, reaching further and further into the organization. Now, here I am shaping health-care policy. This has to be the culmination for our field."