I was encouraged by a little noticed and under-reported ruling by the Internal Revenue Service that could have significant implications for the cost and availability of health insurance. The IRS in effect breached the 1996 cap on the number of Medical Savings Account policies that can be issued by ruling that employer funded out-of –pocket medical expenses are not taxable and that any unspent funds can be rolled over and can follow the employee. Over time, this should greatly increase the incentive for health care consumers to spend wisely and demand more patient-directed coverage features. More choice and greater control by consumers will lead to more individual responsibility and a bottom-up transformation of the system. Ted Kennedy and Hillary Clinton, call your office!