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October 14, 1996

Managed Competition: Who Will Win? Who Will Lose?

Arch Intern Med. 1996;156(18):2033-2035. doi:10.1001/archinte.1996.00440170027002

The MOURNING period after the death of the Clinton Plan for health system reform1 was brief, in fact, nearly imperceptible. Market forces thrust one element of the Clinton Plan, managed competition, to center stage. Will managed competition solve the problems that the Clinton Plan addressed? Will it have serious side effects? This month, JAMA and each of the Archives journals, including the Archives of Internal Medicine, devote special attention to the rapid emergence of managed competition as the dominant force in our health care system.

The 2 facts that have led to cries for health system reform are the progressive increase in health care costs in the United States and the fact that millions of Americans have no access to health care—especially ongoing primary care.

In the 1980s and 1990s, employers were faced with relentless increases in the cost of health insurance for their employees, increases that exceeded the

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