Why managed care?
Managed care reflects our country’s distinctive approach to a universal human challenge. All societies regard some level of health care as a distinctive social good that the society is obliged to provide to its members. However, even in a country as wealthy as the United States, the cost of health care must be contained. Containment requires limits and priorities. Throughout our history the United States has cultivated an optimistic, can-do persona. As Franklin Delano Roosevelt told us, we have nothing to fear but fear itself. Priorities and limits are for the old world, not the new one. In the late 1980s and 1990s health care payers clamored for relief. States referred to Medicaid as the “budget buster.” The automobile makers discovered that health care for employees cost more than steel for automobiles. However, the U.S. persona of can-do optimism prevented us from acknowledging that we could not have it all in health care and would have to set priorities and limits. Not acknowledgin
