In terms of administration, the system is based on a compulsory insurance model, with fee-for-service care funded by mandatory employment-related insurance plans since 1992.

The survey, conducted by telephone, involved 1,140 women with managed care and 351 women with traditional fee-for-service care, all of them younger than 65.

One danger is that the cuts will be steep enough to drive doctors out of fee-for-service care and into private managed care, forcing unwilling patients to come with them.

When Erisa was created in the 1970's, there was no widespread problem with denial of care since most insurance was based on traditional fee-for-service care.

If, as expected, fee-for-service care becomes increasingly expensive, families will flock to H.M.O.'s and many doctors will be forced to follow.

The outside advisers did not challenge the $1,800 and $4,200 estimates, which were based on 1994 projected costs for traditional fee-for-service medical care, not for people in prepaid H.M.O.'s.

With every patient who received a diagnosis of cancer while getting care from an H.M.O., the agency compared two similar patients who had sought fee-for-service care.

But Representative William M. Thomas, a California Republican, points out that insurance companies can't pay for everything and stay solvent, adding that old-style fee-for-service care was overrated anyway.

Future reforms and ideas continue to be proposed, with notable arguments including a single-payer system and a reduction in fee-for-service medical care.

Even those living in the bastion of fee-for-service care, New York City, are finding that out.