* Johnny Munkhammar, program director of the Swedish think tank Timbro: "In much of Western Europe, the free market is considered incompatible with the provision of welfare services... Today, this model has severe problems, not least in health care. In a number of countries, there are waiting lists, where seriously ill people cannot access care for months or even years. There is inefficiency: A recent European Central Bank working paper showed that the bigger the public sector, the more inefficient it tends to be...

      "The US health care system is commonly perceived in Europe to be a complete free market, in which the poor are left to die on the streets if they cannot afford coverage...Increased trade in services combined with new technology could do wonders for the health care of tomorrow. But the way to achieve this cannot be through greater state intervention and control... For anyone interested in improving health care, the market should be embraced, not demonised."

      * Brett Skinner, Director of Health and Pharmaceutical Policy Research at The Fraser Institute in Canada: "Canada has the only single-payer health system in the world among developed nations. No other country has tried to copy the Canadian system because it is a failure. Even Canadians are beginning to reject it. Americans would be making a huge mistake if they adopted Canadian-style health policies for the United States...

      "In 2003, 45 in-patient surgical procedures per 1000 population were performed in Canada, compared to 88 -- or twice as many in the United States. In 2004, 25.5 MRI exams per 1000 population were performed in Canada, compared to 83.2 -- or three times as many in the United States... Canadian patients waited on average 17.8 weeks... between the time they saw their family physician and the time they actually received specialist treatment.

      "The Canadian experience shows that a government-run single-payer monopoly is the worst way to achieve universal health insurance coverage. There are better international examples for achieving universal health insurance coverage if that is what Americans want."

      In contrast to this vision of the future, our country is going through an economic transition that may well guarantee more consumer control of healthcare and less government intervention. This is driven by the fact that employers no longer choose to afford the escalating cost of medical benefits and are slowly finding ways to transfer this responsibility to employees.

      Not too many years ago, the responsibility for retirement savings shifted from employer to employee. Pensions have all but disappeared, replaced by 401{k} plans. Employees who are savvy enough take charge of their own retirement finances and invest for themselves.

      We are now in the midst of a similar shift in responsibility for healthcare financing. Employers are shifting to HSA plans and use HRAs and flex plans to facilitate employee responsibility for healthcare matters. Just like 401[k]s, all this uses pretax dollars.

      Employees took almost a decade to understand and adopt the retirement strategy. HSAs are way ahead of that pace. This shifting responsibility and the economics driving it may be too much for our federal politicians to reverse. I certainly hope so.

       That is one man's opinion. I look forward to hearing yours.

----- Richard L. Taw Jr. M.D.