Managed care premiums do not pay for an insured contract for medical care decided between the patient and the physician. Premiums pay for the management of care (i.e., health maintenance) by a third party.

Unrestricted free choice in medicine health insurance chosen, provided and paid for by the individual has practically vanished. But GOP proposals may help restore the free market to medicine.

Republicans propose to offer every patient a choice to purchase health insurance as an individual neither through an employer nor through government by legalizing Medical Savings Accounts for all Americans. (MSAs are currently restricted to a small group of self-employed, uninsured, small-business people and 390,000 Medicare recipients.) The GOP proposes to make every patient eligible for MSAs, lift MSA caps and restrictions, and grant immediate, full tax deductibility to the individual for health insurance premiums.

MSA opponents, including Kennedy, claim MSAs will attract young, healthy patients, and therefore raise premiums for the remaining population. According to the Treasury Department and private health plans, the opposite is true: One-third of thousands of MSA enrollees were previously lacking any health insurance and the median age for an MSA policyholder is over 40.

The lack of a free market for individual health care coverage, not lack of regulation, led to the domination of managed care. Congress should grant immediate full individual tax deductibility and expand MSAs. Such free-market reform offers an alternative to managed care. Patient power offers what America's free-market health care system needs most health insurance which preserves the right to choose, and pay for, one's own health care.

Scott Holleran is a freelance writer and editorial director of Americans for Free Choice in Medicine, an educational association. His e-mail address is


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