Good managed care needs universal health insurance

Although the increase of corporate managed care has helped to reduce excess es and costs, continued gains in cost-effectiveness depend on good clinical ly managed care. Benefits of clinically managed care depend on stable contr acts and universal coverage. Instead, employers are decreasing coverage and creating a market of "lemons" in which low-cost plans are rewarded for cos t-cutting tactics. These tactics have spawned movements that demand rights for patients and providers. Choosing to shore up those rights, however, wil l increase the number of uninsured persons. This tragic choice, which no ot her industrialized nation has permitted, will not be resolved until some fo rm of universal health insurance is implemented.