To the Editor: In their Commentary, Drs Berenson and Cassel argued against the use of high-deductible health plans and tax-advantaged health savings accounts. They contended that such policies "plac[e] increased reliance on commercial ethics while eroding professional ethics as the guiding force for patient-physician interactions." A physician's fiduciary duty to the patient is of paramount impor-tance, but increased competition for health care services does not inevitably dismantle professionalism. To the contrary, a perfected health care marketplace would reduce unethical behavior.
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