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Having patients weigh costs when making medical decisions has been proposed as a way to rein in health care spending. We convened twenty-two focus groups of people with insurance to examine their willingness to discuss health care costs with clinicians and consider costs when deciding among nearly comparable clinical options. We identified the following four barriers to patients’ taking cost into account: a preference for what they perceive as the best care, regardless of expense; inexperience with making trade-offs between health and money; a lack of interest in costs borne by insurers and society as a whole; and noncooperative behavior characteristic of a “commons dilemma,” in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources. Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients. C ost-conscious health care decision making is necessary, given limited resources and unsustainably rising health care costs. Many medical organizations, health policy experts, and bioethicists consider controlling costs at the provider level to be ethically justifiable if patients are appropriately involved in the decision-making process. An explicit cost containment approach—in which physicians discuss treatment optionswith patients, including the relative effectiveness and costs of those options—has several advantages. Such an approach is more transparent and procedurally fair than implicit formsof cost containment, in which patients are not fully informed when treatment options are limited for reasons of cost containment. Moreover, informing patients about costs allows them to have more input into decisions that affect their own out-ofpocket costs. Yet explicit cost containment at the provider level cannot succeed unless patients are amenable to discussing costs in the clinical encounter. Here we report the results of a 2011 study in which we investigated patients’ attitudes toward considering their own out-of-pocket costs and the insurer’s costs when making medical decisions. In particular, we examined whether participantswerewilling toweighcostswhenchoosing between nearly comparable clinical options, and whether they were willing to accept the less expensive option. Study Data And Methods Study Population Participants were recruited from two geographically distinct locations—the SantaMonica, California, andWashington,D.C., metropolitan areas—by a recruitment agency using a screening protocol (see the online Appendix for the screening tool used). All participants had health insurance, but the population represented a range of ages, races or doi: 10.1377/hlthaff.2012.0686