Advocates of consumer-directed care are disappointed that the steady shift toward higher-deductible insurance, now underway for more than a decade, has not led consumers to become more active shoppers when getting medical services. The lack of transparent pricing is one factor hindering progress, but there are other impediments too. For instance, consumers enrolled in high-deductible insurance usually have access to preferential pricing negotiated by their plans, which makes shopping less necessary, and patients needing high-cost care quickly satisfy their deductibles, after which they are price insensitive. In this environment, providers have weak incentives to disclose prices that invite comparisons with competitors. Numerous public and private efforts are now underway to make pricing more transparent and usable. While some of these efforts show promise, they are unlikely to boost patient price shopping significantly because of their limitations and because the overall market environment does not accommodate an active consumer role. The federal government is the only entity with power and regulatory reach to redirect how the market functions. It should take two steps. First, it should promulgate a required pricing list for a set of common and standardized services and interventions. Second, it should require insurance plans to provide reference-based payments, tied to in-network rates, for all the services on the federal list. Consumers selecting out-of-network providers with prices above the referenced amounts would pay the difference themselves, while those selecting low-cost providers would get to keep the savings. These changes would allow consumers to play a much more active role in the health system, although that role will remain circumscribed by factors that make consumer price shopping infeasible in important circumstances.