Stuart H. Altman and Brian Rosman
Policy analysts have reacted in a wide variety of ways to the sharp growth of managed health care and whether and in what form the actions of managed care organizations should be regulated by government. The chapters in this book demonstrate the wide spectrum of informed opinion. The diversity of responses, we believe, reflects more than differences over factual material or variations in interpretation. Rather, we postulate that fundamentally different premises are at the heart of many of the policy differences evident in their views.
Policy analysts viewing issues like increased regulation of managed care often start from opposite points of view. Some start from the position that markets are ill-suited to the task of providing health care services. These analysts view health care as a public good to be provided to all citizens, as a matter of right, like education or our transportation infrastructure. They are particularly suspicious of managed care because it can be seen as altering financial incentives for providers toward providing less care. They also maintain that the private, for-profit delivery system siphons profits away from the health care system, potentially raising the costs of health care for society. Also, because consumers are not able to evaluate medical judgments, quality can suffer as market competition encourages providers to compete on the basis of cost by cutting corners.
These opponents of unregulated market forces thus start out with the position that the government should play the predominant role in organizing and regulating the health care system. To