Is a major impediment to both good health and lower health costs. A recent report pegs the cost of low health literacy to the U.S. economy in the range of $108B to $238B annually. This represents between seven and 17 percent of all personal healthcare expenditures. Some 36 percent of the U.S. adult population has basic or below basic health literacy levels.

It’s difficult for even “literate” people to navigate the healthcare system: reading and filling out forms, communicating with providers, following basic instructions and assessing options in a system that is opaque at best and is often conveyed in dense, technical and jargon-filled language. That’s not even mentioning cultural and language barriers, no health insurance, etc.

So imagine this: In the future everyone gets a means-tested voucher to purchase health care in public and private plans. Plenty of choices, lots of people selling stuff that is targeted to their particular “needs,” greater transparency on cost and quality, markets working to maximize efficiency. Some people would no doubt figure it all out, but if the abysmal assessment of current conditions of health literacy is any guide, many people would not.

It’s one thing to be “free” to make choices in a dynamic marketplace, and quite another to be free from the impediments to exercise choice wisely. Until we address health literacy head on, both in how we design the incentives for a transparent and integrated system, and how we provide the tools and education to help people make wise choices about their health, health care costs and disparities will continue to increase.