The United States health care system under managed care. How the commodification of health care distorts ethics and threatens equity.

Describing the U.S. health care system means describing managed care under commercial forces. Managed care creates new moral tension for practitioners, but more importantly, in its current form it intensifies the commercialization of health expectations and interactions. The largely unregulated marketing of health services under managed care has been a major factor in the increasing number of uninsured citizens, while claims for cost reduction through managed care are equivocal. Risk-rating practices integral to the current medical marketplace thwart concerns for justice in allocation and create vulnerabilities for almost everyone. The political-moral concern of the early 1990s for a right to health care is nowhere in sight.