But its cost trend over the decades has paralleled that of fee-for-service medicine.

A hard move away from fee-for-service medicine would be the best approach.

First, some mistakes are always made; fee-for-service medicine was hardly perfect.

Health maintenance organizations and other arrangements less costly than fee-for-service medicine would be encouraged.

Disadvantages: To hold down costs, most companies would contract with health maintenance organizations rather than allow fee-for-service medicine.

"Outcomes under traditional fee-for-service medicine were not always ideal," he adds.

Ultimately, real cost control will require a strong push away from fee-for-service medicine.

Few people say that the old system - traditional fee-for-service medicine - was ideal.

"It's a very different process from regular fee-for-service medicine."

These plans, hybrids of managed care and fee-for-service medicine, steer patients to certain providers.