In a bit of end of year silliness I got involved in the comments over at Robert Prather’s post  at Insults Unpunished about HSA’s in the new Medicare bill.  There’s no doubt that HSA’s have a greater chance of success than the MSA’s they replace but Robert and I disagree about how easy it is for doctors and pharmacists to be transparent enough about their pricing to allow a real market to develop.  The comments are worth reading though, particularly some of those from Don Johnson who as usual injects a serious and balanced view from the right into the discussion, and has some perceptive things to say about why managed competition has never gotten far in the policy world.

Meanwhile, The NY Times reports on the related issue of out-of-network doctors counteracting the attempts of what’s left of the managed care industry to restrict members to tight networks.  The Times found that in several states Some Doctors (are) Letting Patients Skip Co-Payments. Of course it’s those co-pays that are supposed to keep the managed care patients in network. If doctors are prepared to work for UCR fees minus the patient’s co-pay/co-insurance, then what’s left of the managed care plans’ efforts to control medical care using loose networks is doomed.