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October 23, 1996

Who Benefits From Medical Savings Accounts?-Reply

JAMA. 1996;276(16):1299. doi:10.1001/jama.1996.03540160021018

In Reply.  —Putting the patient in charge, as Dr Guazzo recommends, may be a good idea, but to make socially optimal decisions, patients need to face the full costs of care. The implicit tax subsidy to MSA savings and the reasonable chance (20%-37%) of exceeding the catastrophic deductible prevents this. If we could limit the tax subsidies of health insurance, people would have more incentive to choose plans in which they paid a higher percentage of the costs of care.Dr Kastner and colleagues assert that "consumers will choose the plan with the lowest out-of-pocket cost." If so, their figure implies that healthy people should choose FFS and that sicker people should choose HMOs. In fact, HMO enrollees are healthier than those remaining in FFS.1 Our model of choice was based on many factors besides out-of-pocket payments and assumed the value of choice of physician and of amount of treatment is