Government now accounts for almost half of total U.S. health care spending. Critics point out that removing market forces removes the discipline that individual consumers impose. Diminishing consumer concern may account for increasing health care costs this decade.

• In 1996, public health spending grew at twice the rate of private spending -- 6.1 percent versus 3 percent.

• Medicare accounts for four of every 10 dollars the government spends on health care -- and it grew by 8.1 percent in 1996.

• Spending for Medicaid increased by 5.3 percent.

• By contrast, private spending on health-insurance premiums -- which represent about two-thirds of private health-care spending -- grew just 3.2 percent, while individuals' direct payments for care increased at the same rate as overall inflation, 2.7 percent.

A number of health-policy analysts contend that medical savings accounts -- which allow individuals to pay for their health care directly -- will act to contain medical costs once more Americans sign up. Managed-care programs may have acted as a brake on escalating health costs, but some patients have turned against them when they discovered they couldn't get the services and procedures they thought they should have.

With government assuming increasing responsibility for health services, many analysts predict ever-increasing levels of government rationing. That's why medical savings accounts look particularly attractive.