It may sound healthy, this debate we're hearing in Washington over a "Patients' Bill of Rights." But it's like listening to prisoners clamor for better food and more yard time. No matter what the outcome, they're still prisoners. What they should be angling for is early parole.

That's why it was disappointing to hear President Bush outline what he wants to see in a "Patients' Bill of Rights." Yes, his vision differs slightly from the leading congressional proposal sponsored by his former presidential rival, Sen. John McCain, R-Ariz., and Rep. Greg Ganske, R-Iowa. But both largely preserve the status quo and don't allow the prisoners -- i.e., Americans with private health insurance -- any opportunity for freedom.

More than 42 million Americans lack health insurance today, mostly because they work for small firms that don't offer it and because they can't afford to buy it themselves. A "Patients' Bill of Rights" won't do them any good.

What about those who do have health insurance? The "Patients' Bill of Rights" does absolutely nothing to give these people a greater choice of health plans. More than 90 percent of them get coverage through their employers. Less than half have any choice among plans, and it's typically from a very short list chosen not by them but by their employers.

If they're not satisfied with their insurer for any reason, that's tough. Ask yourself: When's the last time your employer asked for your input?

Essentially, workers are forced to buy health insurance through their employers or go without coverage. Given this limited choice, it should come as no surprise that a lot of people feel dissatisfied with their employer-sponsored plans and are frustrated by the fact that they can't do anything about them.

Many have complained to their congressman about their HMOs and demanded that "something be done." Well, a "Patients' Bill of Rights" may be "something," but it addresses the wrong issue. The question shouldn't be: How do we make employer-provided health plans more responsive? The question should be: How can we reform a system that makes it all but impossible to get affordable health insurance other than through your employer?

Most Americans wouldn't think of letting their employer choose insurance policies for their automobiles or their homes. So why should they let their employers choose a health insurance plan for them and their families? If workers had a real choice, insurance companies would have to compete customer by customer for business, forcing them to become more responsive without a "Patients' Bill of Rights."

Two alternatives to what Congress and the administration have proposed would finally give American workers real decision-making power in health care. One would let employers offer "defined contributions" -- a set amount individuals can use to buy coverage from the health plan of their choice.

These would work much like the 401(k) contributions many employers now make. Employers would perform the clerical duties and leave the important decisions to their employees. Employers merely send a check -- which includes their contribution and employees' contribution withheld, as now, from their paychecks -- to the insurance company chosen by each employee. Employees get the coverage they want, and employers no longer spend even one minute shopping for insurance.

Second, Congress can make refundable tax credits available to workers whose employers don't offer health insurance. This would give lower-income workers, who make up most of the uninsured, access to the same level of health benefits typically offered to higher-income workers. The credits also would give them the leverage a "Patients' Bill of Rights" is meant to provide. Employees who buy plans directly from insurers become party to the contract. If insurers don't live up to the contract, employees can -- and should -- sue.

But by its very nature, an employee-controlled system of health care would make this course of action far less necessary. Say you went to a restaurant and had lousy service or a bad meal; you wouldn't sue unless you ended up in the hospital. Instead, you'd vow never to return to that restaurant and tell your friends to steer clear as well.

In our present employer-based health-insurance system, most Americans have no choice but to continue eating at the restaurant that made them sick. No wonder they see the courts as their only option. Wouldn't it be nice if they could just eat somewhere else.

James Frogue is a health care policy analyst at The Heritage Foundation (www.heritage.org), a public policy research institute.