Is managed competition a field of dreams?

In recent months, managed competition has gained the upper hand in the debate over how to reform the U.S. health system and likely will be a part of President-elect Clinton's proposal. But recent data reveal that managed care plans, an important piece of the managed competition approach, have not significantly altered the rate of increase in costs. These findings cast doubt on the assumption by managed competition advocates that the proper incentives exist to cause the health delivery system to reorganize itself.