Medical costs have more than doubled over the last decade, and health insurance premiums have risen nearly five times faster than wages. Americans are spending far more on health care than residents of any other industrialized country while receiving lower-quality care overall. Meanwhile, big U.S. businesses that provide health coverage to workers complain that the high costs are crippling their ability to compete with companies abroad whose workers get government-subsidized care. The Bush administration is encouraging consumers to switch to consumer-directed health plans, whose high copayments would force them to shop for more cost-effective care. But critics argue that individuals can do little to control costs. Instead, they argue, the plans would primarily benefit the wealthy and that society must make hard choices about which care should be paid for by public and private dollars.