Americans were handed - some might say had forced upon them - control of their retirement funds 32 years ago with the creation of the Individual Retirement Account. The 401(k), invented four years later, cemented the idea that individuals must take more responsibility for their financial future. 

Now Americans may be pushed to take more control of another aspect of their finances, their health care spending. They may face more choices and more direct payment of costs. They will be urged to set up Health Savings Accounts, a 401(k) for medical bills. 

As anyone who tried to manage a retirement account in those early years quickly discovered, managing money yourself isn't easy. There were few tools to tell the amateur investor how to handle what were hopefully called self-directed retirement accounts. Smart companies, like Fidelity Investments, saw that opportunity and became giants by helping consumers with the tasks. About 70 percent of American households now have more than $6.7 trillion in some form of self-directed retirement plan, according to the Investment Company Institute, a trade group of mutual fund providers. 

The idea of a consumer-driven health plan is daunting, because most Americans have found it so difficult to navigate the present system. The ill are swamped with hundreds of bills and statements and there is little help available to understand them. They must choose the right treatment, doctor and hospital and hope that their illness won't cause them financial ruin. 

The basic problem is the lack of consumer information. Imagine trying to decide which mutual fund to buy without a clue about the price until after the purchase. Most people find out the price of a medical test or procedure only after receiving an "explanation of benefits" and then only if they can decipher it. John M. Engler, president of the National Association of Manufacturers, blurted out at a health care conference in December: "We need Quicken for health care and we need it now. We need to get the 1.0 version out there." 

Actually, not only is there a Quicken for health care, called Quicken Medical Expense Manager, but Intuit, the maker of Quicken, TurboTax and QuickBooks accounting software, has just released Version 2.0. The software isn't the panacea that Mr. Engler, the former Michigan governor, had in mind, but it is a step in the right direction to help those managing the mounting bills of a seriously ill person.

There is a consumer market for such a $50 piece of software because insurers have made bill paying so complicated. Is there a way to become better informed about the choices available when you or a family member gets sick? The short answer: No, not yet. Advice is available on WebMD.com, and USNews.com ranks the best hospitals and best health plans. But when it comes to prices, you get to see only the information your insurer and doctors let you see. And it's hard to change that because your employer, not you, picks the insurer.

"Consumerism has changed every facet of society," said Ronald A. Williams, Aetna's chief executive officer. "The one area that hasn't been changed is health care." 

There are some signs that insurance companies see an opportunity and want to seize it. Aetna, one of the biggest insurers, has created a Web site that helps 500,000 of its customers with self-directed plans understand some of the costs of medical care.

"Where companies like ours can add value is in information technology," Mr. Williams said. The insurer is in a unique position to gather information about a patient as well as doctors and hospitals and share that data so the patient gets better care at the right time for less. "We asked ourselves, 'What do we have to invent?' " Mr. Williams said.

Like most other insurers' sites, Aetna's is open only to its customers. But the site is considered the model of clarity in an opaque industry. 

The Aetna site makes the explanation of benefits a bit easier to understand than most insurance companies' statements. The online explanation of benefits shows the "submitted charge" and the "negotiable allowance." But then it gives a bottom line: "Member responsibility: $50." You know what to pay.

That helps when it comes to bill-paying. How about help on what to buy? Aetna makes some effort to expose costs to consumers. You type in the name of the drug you are prescribed, the dosage and the state you live in. The site's software compares the cost of the drug at a local pharmacy to Aetna's own mail-order service. In the case of 20-milligram tablets of Lipitor, a cholesterol-lowering drug, the site tells you that the retail pharmacy in California would charge $107.59 for a 30-day supply, and that you would pay $35 for it. It says the mail order drug would cost $296.76 for a 90-day supply and you would pay $70. 

Aetna's calculator fails to take one more necessary step. It does not spell out that the mail-order pharmacy is 33 percent cheaper. The visitor has to do the math, and if he doesn't catch the difference in days' supply, he may conclude that the local price is better and end up paying more. The site does list alternative drugs - a 90-day mail-order supply of 20-milligram tablets of Zocor, another cholesterol-lowering drug, would cost more, $393.62, but would cost the patient less, only $40. 

The site uses data from WebMD Quality Services to compare hospitals in the customer's area. For any given procedure, it uses criteria like mortality, chance of complications and length of stay to determine the best hospital. But it doesn't list the prices of those procedures at the various hospitals.

A pilot program in Cincinnati will, however, give Aetna's customers there online access to the actual discounted rates of 25 most common in-office services offered by doctors. "We've done something unique," Mr. Williams said. "It is about transparency on cost and clinical effectiveness." 

The National Association of Manufacturers, a lobbyist for big companies, says making consumers aware of prices is a necessary step. "If we are going to make health care more responsive and more consumer-friendly," said Neil Trautwein, the trade group's chief lobbyist on health care issues, "we will have to have better information to compare price and quality." 

As Americans build up money in their Health Savings Accounts, the funds become as much a retirement account as a kitty for medical expenses. What consumers will need are more sophisticated financial tools. Insurance companies "are missing an opportunity to help them with their health care expenses," said Eric G. Brown, the research director for health care and life sciences at Forrester Research. 

While the Quicken software doesn't help people compare prices, it is a useful tool to manage expenses. And the reports it generates can help in planning contributions to next year's Health Savings Account or Flexible Spending Account. A bar chart tracks how close you are to reaching your deductible limit or out-of-pocket maximum.

The software is created to tell you what to do when a piece of paper from the provider or payer arrives and gives you the confidence to pay only what you owe. "To be smart shoppers, they need a tool to help manage decisions efficiently," said Bruce Barnhart, the product manager for the Quicken software. The program allows you to track expenses for the entire family or for an individual. It also tracks veterinarian bills.

When that dreaded explanation of benefits comes in, the user is asked to enter the information into the program. It calculates the "provider write-off," and tells you how much you owe. If there is an error, the program can generate a dispute letter that uses the language of the insurance industry.

The one major problem with the program is that all the data must be typed in by the user, as one did with the original Quicken financial software. That wasn't a problem back then because we didn't know any better. But now your credit card, bank and investment statements can be downloaded every day into the financial program. 

Automatic entry for medical software will arrive, just not soon. Forrester found that nearly all claims coming from hospitals are sent electronically, and nearly 60 percent of those from physicians' offices are in digital form. 

One day that data will flow directly to the consumer in electronic form so that software can massage the numbers and provide insight into costs. "We are still quite a ways off from this happening in health care," Mr. Brown said.

For those who are disciplined enough to enter their data consistently, he said, the Quicken data becomes a complete electronic health record. It can be the ideal place to look up prescription histories, doctor's office visits or other medical events. 

It's a start.