President Clinton's managed competition proposal.

In the search for fairness of access to health care, value for the money spent, and high quality of patient care, the United States has vacillated between advocacy of government regulations (the 1970s) and of market-driven, pro-competitive (1980s) approaches. The possible enactment of President Clinton's health reform plan with a managed-care strategy (1990s) calls for paying physicians and other providers in a manner that often induces them to minimize the provision of services to patients per episode of illness. This article discusses the impact of such legislation on patients, physicians, and other providers. It then argues that the President's managed competition approach, which micromanages health-care services, will fail except by concurrently implementing his proposed National Health Board's global budgetary concept. The major reason is that health reform for the 36.6 million uninsured Americans, who are mostly the working poor and their dependents, is only practical and affordable if stringent policies are adopted that reorganize available health-care resources and simultaneously implement cost-containment constraints.