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POPSWake The Hell Up America! Enough Is Enough The broad ideological battle over the role of markets remains a basic dividing line and dominant theme in American health policy. The premise of what has often been called “managed care” is that in too many cases the wrong services are provided and that the right set of incentives or form of organization would lead to the right services provided to the right people at the right time. The theory of managed competition thus promised that a more market-oriented approach would increase value for money spent, by leading to better-informed or more prudent purchasing. Unfortunately, in order for any kind of “market-oriented” reform of American health care to have significantly positive effects on cost, access, and quality, it would have to include such substantial restrictions on the normal ways of doing business in U.S. markets that it would be barely recognizable as “market oriented."
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