Governor Spitzer is only now discovering how difficult it is to try to rein in the cost of health care. Senator Clinton slipped on this banana peel issue some time ago, and others will surely follow.

The rising cost of taking care of the nation’s sick has become one of the major health issues for the economy. Health care expenditures in 2006 are estimated at $2 trillion, and are forecast to rise to $4 trillion in 2013. The problem is so complex and the interest groups so embedded as to be overwhelming. It’s a wonder we haven’t fallen back on that crisis management tactic so peculiar to our democracy and created a health care tsar.

It’s also a wonder that engaging the consumer — a proven and effective tool for containing medical expenses — has, until recently, been woefully neglected. Allowing the patient to become an informed decision-maker would need relatively little investment but does require a change in viewpoint, which may be just as challenging.

Consumerism in health care is a rapidly growing field being fertilized by the Internet, of course. Information hitherto guarded by doctors, insurers, and pharmaceutical benefits managers, among others, is now seeping into Web sites and chat rooms, raising questions and empowering consumers.

Consider a privately owned company called ClinicaHealth, founded by David Greene. Mr. Greene suffers from Von Hippel-Lindau syndrome, a rare genetic disease afflicting just 10,000 people worldwide. Frustrated by a lack on information available about his illness, Mr. Greene reached out over the Internet and formed a support group. On the secure site, people share personal histories, advice on symptom management, and anecdotal information relevant to patient support and care.

The discovery was a turning point in Mr. Greene’s life, inspiring him to develop similar networks for other diseases. Clients include such organizations as the Lung Cancer Alliance and the Arthritis Foundation.

The economic opportunity for Mr. Greene is selling ads on the Web sites and the probability of his firm producing patients available for drug industry clinical trials. These trials involve more than 1 million Americans each year; drug companies spend untold time and more than $3.75 billion recruiting these patients. As part of the support group sign-up, joiners are asked if they would be willing to participate in a trial. More than 80% are interested in doing so.

Mr. Greene was one of the participants the other day in a roundtable discussion hosted by a group called Lyceum Associates, headed by Syd Williams. Mr. Williams provides a forum where fund managers, private equity investors, and corporate types can exchange information and ideas on topics of interest, and he follows this up with publications available by subscription.

Also at the forum was the president of StrongSquare, Ron Davis. This start-up company provides information on drug pricing and alternative medications on the Internet to pharmacy benefits managers and health plans. It also acts on behalf of employers to make sure their employees are getting the lowest possible prices on drugs. The broader goal, ultimately, is to allow consumers to buy their medication at the lowest cost, from the best available sources. The company informs consumers about generic alternatives, for example, or suggests less expensive substitutes in the same therapeutic category.

“I can help a consumer drop the price of his medications by 60%,” Mr. Davis says. Given that prescription drug outlays totaled more than $200 billion last year, such savings could be a big help in controlling medical costs.

Even people who are covered by a health plan could benefit materially from the information available from StrongSquare, according to Mr. Davis. As companies attempt to hold down their plan costs, many have resorted to increasing the employees’ share of the costs, known as the co-pay. As co-pays rise, consumers are shelling out more for prescription drugs. Access to the StrongSquare program could allow them to look for drugs with lower co-pays.

At the moment, StrongSquare is still operating mainly through PBMs and health plans, but that could change. The company is in discussions with the office of the governor of Washington, home of StrongSquare, about a new state program to help uninsured people buy drugs at lower prices. There is a chance the company will soon be able to provide uninsured consumers with the kind of pricing information hitherto available only to corporations.

The CEO of Medication Management Systems, David McLean, offers a different approach to trimming health care costs. His company is involved in medication therapy management, a fast-growing service that attempts to optimize a patient’s drug regimen. The concept is that a pharmacist, in conjunction with the primary care provider, reviews a patient’s complete list of medications, including dietary supplements and alternative medicines, and checks to see that they are appropriate, effective, and safe.

The rationale for this extra layer of care is that an estimated 70% of people taking medication will at some point be harmed by the drugs they take. The damage done through patients being given inappropriate prescriptions or through harmful drug interactions costs the country some $100 billion every year. MTM has only recently become a reimbursable expense, which opens the door for substantial growth.

All of these companies surely underscore the value of making more medical information available to the public. There has been continual chatter about the need for electronic health records, but the medical community is indeed slow to innovate. As in other sectors of the industry, it may well be that corporations with profits at risk finally undertake measures that move doctors and hospitals forward in this area.

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