Presidential candidate Rudy Giuliani wants health insurance to operate more like car insurance.

People would shop around for plans that suit them best - young, healthy people may opt for the equivalent of liability insurance, while the ill or risk-averse might choose a fuller coverage plan. Those who take good care of themselves would, like good drivers, benefit from financial savings. And insurance companies would compete for consumers, improving quality of care while offering lower prices.

But critics of the plan say a free-market approach doesn't translate directly to savings in the health care insurance market. Giuliani's plan could leave the elderly, the poor and the sickest priced out of the market. And if his plan doesn't provide insurance to everyone - so far, Giuliani hasn't said he would - the cost of providing care to the uninsured could continue to drive up costs.

"The individual insurance market has never operated like a typical market," said Sara Collins, assistant vice president at The Commonwealth Fund, a New York-based private foundation that pays for health care research. "It doesn't fix the problem, because you still have 44.8 million people who are uninsured."

Health insurance premiums continue to rise faster than inflation, causing small businesses to drop health care coverage and leading some low-wage earners to forgo coverage altogether. The uninsured end up costing more, since they don't visit a doctor until a condition becomes serious, requiring more treatment.

While Democrats have focused on making health care more affordable to lower-income families or finding a way to insure everyone, Giuliani suggests a consumer-driven approach that gives health care buyers more control.

So far, Giuliani hasn't offered many specifics. Speaking in Bedford on Tuesday, the former New York City mayor said he would like to give everyone a $15,000 tax deduction so people can buy their own health care plans and invest any leftover money into a health-savings or retirement account. The plan resembles one that President Bush announced last year, except Bush proposed giving a $7,500 tax break to individuals and a $15,000 break to families.

Supporters say having people buy their own insurance is a step in the right direction. People may take better care of themselves and shop for the best deals if they see the money coming out of their own accounts, said Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy, a local think tank.

"You don't have any idea what health care costs," he said. "Very few people do. They don't need to know. It's somebody else's problem."

Allowing individuals to purchase plans on their own rather than through an employer could help people eliminate benefits they don't need or want, which could also save on costs, said Regina Herzlinger of the Harvard Business School.

"I'm sure I would do a better job of shopping," she said. Employers "have no idea what I want. They're buying me a Mercedes when I really want a Toyota."

Although Herzlinger supports Giuliani's idea in general, she said there are problems with having individuals, rather than employers, buy health insurance. Employers insure all employees - young and old, healthy and sick - which helps even out the risk insurers face in covering health care costs for a group. That keeps premiums level.

If the groups are split up and people shop for plans on their own, healthy people would have no trouble buying a plan. But those with chronic diseases could find the rates too high or may be unable to find a company willing to insure them.

"The sick will get locked out of the market," Herzlinger said. "Giuliani hasn't talked about that at all."

Collins worries that if people treat their health care as a way to bargain shop, they may be less likely to pay for expensive preventive-care measures, such as colonoscopies, which can avert more expensive treatments that would be required after a serous illness develops.

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