I've had four MRIs over the past four years but, unlike with my last grocery bill or most recent shoe purchase, I have no idea what a 30-minute stint in the cylinder actually costs. That's because I'm one of the lucky workers with full employer-provided health insurance with copays, even.

That's a contrast to the millions of workers who are now enrolled in high-deductible health plans. With the recession walloping businesses and consumers over the past two years, enrollment in these plans which have lower monthly premiums, but also higher deductibles and out of pocket for services has accelerated. Large carriers, including publicly held health plans and Blue Cross Blue Shield plans, are reporting double-digit increases in consumer-driven health plan enrollment in the soon-to-be-released health plan membership census conducted by HealthLeaders-InterStudy. High deductibles are a hallmark of the CDHPs.

Having a high-deductible insurance plan forces consumers into making choices. Prescription drugs or a full tank of expensive gasoline. College textbooks or elective knee surgery. According to some large insurers recent financial reports, their members may have chosen the gasoline and textbooks, and not necessarily the medical care.

In addition, the industry has taken big bites from the low-hanging fruit in trimming medical costs: Generic drug utilization rates are as high as 80 percent at some carriers; imaging costs are way down, thanks to the mother-may-I approach of radiology management vendors; and hospital re-admission is a bad two words everybody's working on that one.

All of that combines to have created a slowdown in medical spending increases over the past few quarters. While the growth rates still well exceed general inflation, the shifts have interesting implications for healthcare reform. If we really are developing discipline around healthcare consumption, perhaps the country will be in a better position to undertake the costs of insuring more Americans.

The trend could all collapse once the economy recovers, but the belt tightening (for everyone but health plan CEOs, of course) may be just the medicine healthcare reform needs.

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