The current system, he said, which is based on a pre-payment paradigm, creates no vested interest among consumers to care about costs, and no incentives for physicians to control costs.

Rep. DeMint noted that he has sponsored legislation aimed at altering these incentives by establishing consumer-directed, or "consumer choice," health plans that provide individuals with more control over their health care decisions. "If we don't reform health care, we will have a one-payer system," he said.

As an example of what a government-run single-payer system would look like, Rep. DeMint cited the education system in the United States.

The United States, he said, spends more on education than any other program. But because of the lack of choice in the public education system, Rep. DeMint said, it is one of the worst in the industrial world.

Rep. DeMint dismissed concerns that consumers are not smart enough to make health care financing decisions. Currently, he said, information on health care financing is written with an eye on those who have the money, which are insurance companies.

When consumers gain control over their own health care decisions, he said, information will be presented with individuals in mind.

Rep. DeMint, who is running for the open Senate seat in South Carolina, said that visits to his constituents reveal how much dissatisfaction exists with the present system. "America's health care system truly hangs in the balance," he said.

The HIAA symposium featured a presentation by Bill McInturff, a partner with the Alexandria, Va.-based polling firm Public Opinion Strategies, who said consumers react favorably to "consumer choice" health plans and many would consider changing from their current plan.

Mr. McInturff noted that these types of health plans, such as Medical Savings Accounts and Health Reimbursement Accounts, traditionally have been termed "consumer driven" health plans. However, he said, his polling indicates that individuals react much more favorably to the term "consumer choice" than "consumer driven."

It is time, Mr. McInturff said, to change the name of these plans.

More substantively, he added that consumers react very favorably to descriptions of consumer choice plans.

Consumers, Mr. McInturff said, like the fact that consumer choice plans provide more choices than many current plans of providers, allow health care expenses to be paid with pre-tax dollars and allow money in health savings accounts to roll over year-to-year.

He said, however, that consumers are concerned about high deductibles and they find consumer choice plans confusing.

Employee benefit executives, Mr. McInturff said, expressed concerns that the plans offer too much choice to employees, who may not be comfortable making these types of decision. In addition, he said, benefit executives believe these plans may be difficult to implement?with employees having different premiums and different networks.

Still, he said, early feedback from employers who do offer consumer choice plans suggests very high employee satisfaction rates.

Mr. McInturff said that primary care physicians also may offer significant resistance to consumer choice plans, and some of the core concepts associated with them, such as quality measures and price comparisons.

He noted that surveys indicate that criticisms of health maintenance organizations from physicians had an impact on consumer perceptions of HMOs.

Before this negative loop is created again, Mr. McInturff said, an appropriate next step would include more research and communications with physicians.

Ron Pollack, executive director of Washington-based Families USA, a health care advocacy group, responding to Mr. McInturff's presentation, said the desirability of these plans depends on the details. These include the size of the deductibles and what health care expenses can be paid for with the accounts.

From an employer's perspective, he believes the key question will be whether these plans will save money. If so, Mr. Pollack asked, will costs be passed on to employees? If this is the case, he said, these plans will likely become sources of contentiousness.

He added that he is skeptical about suggestions that these types of plans will achieve savings by encouraging better health care shopping by consumers.

If the plans are just a pretext for more cost shifting, Mr. Pollack said, they will not be popular among consumers.

Finally, he said, one of his major concerns is what he called the "flip side" of consumer choice, which is segmentation. While segmentation is not a bad thing in other markets, he worries about it in the context of health care. Mr. Pollack said he is concerned that segmentation would make things worse for people who are already more vulnerable.