In reply
Blumberg argues that capitalist markets that "function under imposed restraints . . . allow scarce, life-sustaining resources to reach all members of a society," whereas state-controlled systems make decisions "from the top down" resulting in a lack of initiative and a paucity of new ideas. The author believes that managed care, while it could stand improvements, has a good chance of addressing our problems. He states that "the answers we get from managed care organizations . . . are usually messages carried and explained by physicians." If by this the author means that physicians working in the managed care arena play a significant part in determining the policies of managed care associations, I fear that he is in error.