Ready, aim, fire! That’s right, folks, step right up and take a shot. After all, someone has to be the villain, and the health insurance industry is tailor-made for the role. It is big; it is impersonal; and, more importantly, virtually every interaction one has with an insurance company is negative. Hassles with claim filings, rejected claims, appeals, and annual premium increases all conspire to predispose individuals to think of their insurance companies as necessary evils worthy of any vilification. So, why not extend this disgruntled ire to blame the insurance industry for the dual problems of limited access and rapidly rising health care costs? While the situation is not totally surprising, one cannot help bu t be a little astonished at the depth and breadth of anger with the private health insurance industry. At least since the mid-1950s, the industry has performed in a classic, although not perfect, agency relationship with its purchasers. In large measure, the policies insurance companies sell reflect the interests, desires, and demands of purchasers. To the extent this is true, we are shooting the insurance company messengers for our society’s collective moral failure. If we were honest, we would admit that private health insurers are doing precisely what they should: serving the interests of purchasers by competing among themselves to develop low-cost products. To do less would be organizational suicide. In fact, purchasers have gone so far as to punish those insurers that attempt to perform any sort of redistribution of wealth in society. Consider here the decline in the market share of Blue Cross/Blue Shield plans, which, while not solely attributable to the continuance of community rating, certainly reflects its influence and the astonishing rate of growth observed in self-insured arrangements since the passage of the Employee Retirement Income Security Act (ERISA) of 1974. Both the decline