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March 13, 1996

Market Reforms for the Health Care System-Reply

Author Affiliations

Columbia University New York, NY

JAMA. 1996;275(10):756. doi:10.1001/jama.1996.03530340019014

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In Reply.  —The criticisms by Dr Honbo suggest I assumed that the health insurance market has been a free market and that the consumer lacks the knowledge and ability to pick his or her own insurance. In fact, I have long been opposed to the hidden federal income tax subsidy to both employees and employers in their purchase of insurance coverage, and I have never expressed a view about consumers' ability to select their own insurance policy. But I definitely believe that insurance needs to be a regulated industry. Congress did not decide to regulate the Medigap market just for fun!Next, Dr Steinberg holds me in error because I failed to appreciate that all the bad things that have happened, such as executives of managed care programs ripping off employees and providing incentives for physicians to skimp on treating patients, reflect governmental interference, such as the HMO Act of