FOR all the talk about the right to sue a health maintenance organization, this summer's best-kept secret about HMO reform is that the legislation would partly restore the right to choose one's health care.

This barely noticed provision of the current HMO reform bill would radically reshape the way each individual uses the medical profession.

If the provision is included in the final bill approved by President Bush, the patient, the physician and the employer will reap enormous rewards, and those much-maligned managed-care companies, including HMOs, could face real competition.

While Congress debates the precise circumstances under which a patient may sue an HMO, the point may be moot. An obscure provision of the HMO bill would permit each American to flee HMOs and preferred provider organizations by opening a medical savings account, currently available only to the self-employed and small businesses.

Expansion of MSAs to all Americans is no trivial matter. It offers the employee and the employer an opportunity to save money on health insurance premiums while gaining unrestricted, free choice among doctors and hospitals. No lists, no co-payments, no gatekeepers.

MSAs also provide today's physician what he or she desperately needs most: professional autonomy.

Here's how an MSA works: Combining catastrophic health insurance with a savings account to cover expenses, the employee or employer pays a monthly premium for health insurance - a high-deductible policy which covers every penny over the deductible. The higher deductible means lower premiums, fewer restrictions and better health care.

Under MSA plans, the patient schedules an appointment to visit any physician - without obtaining permission from a committee. There is no pre- approved network. There are no co-payments, no requirement that medications be generic and no sense of dread that a treatment may be denied or perpetually delayed.

The MSA also allows the employee to earn money. The employee or employer makes an annual, tax-deductible contribution to the medical savings account policy.

Unlike flexible savings plans and 401(k)s, the money earns interest and rolls over each year, and the account is owned by the individual, not by the employer. The money, which may be invested in mutual funds, can be used for medical costs - vitamins, chiropractic, vision, psychotherapy - with neither tax nor penalty. Or the employee can choose to pay out of pocket and let the MSA earn interest. There is no need to use it or lose it.

MSA plans are like having an individual retirement account matched to an insurance policy with few restrictions.

As American Medical News put it after MSAs were introduced on the market: "Medical savings accounts appear headed to be a hit. ... What consumers and employers are responding to is the best deal in health- care coverage in a long time. The result is a policy that combines affordability, choice and access to care - critically important qualities that have suffered a rapid decline in the past few years for millions of Americans."

The enthusiasm for MSAs is genuine. Upon their approval by Congress in 1996, BusinessWeek declared: "America's health-care system is about to take a giant step backward - to the nearly forgotten era when patients chose their own doctors."

Generally, MSA patients report that physicians are more friendly, professional and discerning than HMO and PPO doctors. It's little wonder why. Doctors know they'll get paid for their work. MSAs are win-win-win for the patient, physician and insurance company.

Expansion of MSAs is supported by banks, physicians, patient advocacy organizations, insurers and partisans on each side - including President Bush and Democratic Sen. Robert Torricelli.

MSAs have their critics, who claim that MSAs will attract only young, healthy patients. But, according to Treasury Department statistics and industry reports, the opposite is true: The typical MSA patient is 43, and one-third of patients were previously uninsured.

If the MSA provision is uncorrupted by Congress and approved by President Bush, it will mark the first time in decades that patient and employer alike will have a fundamental choice among health care plans: managed care or real, quality insurance.

Some patients prefer an HMO, and that's their right. For the rest of us - those who prefer high-quality health care and a range of choices - an affordable alternative to HMOs awaits the approval of Congress.

If Congress and the president really want to protect the patient's rights, they must fully expand MSAs without restrictions and without delay.

　　From Healthy.net