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March 13, 1996

Market Reforms for the Health Care System

Author Affiliations

Encino, Calif

JAMA. 1996;275(10):755. doi:10.1001/jama.1996.03530340019011

To the Editor.  —Dr Ginzberg1 makes two fundamental errors in his recent assessment of our health care system, which in turn, make it impossible to arrive at a correct solution.First, Ginzberg incorrectly assumes that the health insurance market has been a free market. Quite the opposite is true. Since World War II, the private health insurance industry has been largely an employer-based system in which the consumer is out of the loop. Rather than having the consumer choose his or her own insurance policy, his or her employer has been the one to do so. This approach arose out of the wage and price controls of the 1940s and is really a way to give a worker nontaxable income (by calling it a benefit instead). It is not unexpected that the bureaucratic tinkering of the 1940s has led to the insurance crisis of today. One solution to the