Selective chaos

A great battle is being waged in America today for the hearts, minds, and p ocketbooks of health cave consumers. Managed care, once seen as an efficien t and prevention-oriented approach In the management of medical services, i s fighting for its conceptual life against allegations that it is sacrifici ng health care quality in the name of controlling costs. While data and ane cdote are far from unanimous in supporting this conclusion, many doctors an d patients have registered these complaints as they attempt to navigate the evolving systems of managed care We present two of those voices in the fol lowing essays, not in the spirit of gang-tackling managed care but, rather, in an effort to pin point problems in the system that warrant concern and perhaps, redress. The commentators in these Essays, a practicing internist and an obstetrical patient, bring special perspectives to their reflections . Thomas Bodenheimer is a national correspondent for the New England Journa l of Medicine, in addition to practicing medicine in San Francisco; Sara Si nger staffed the California Managed Health Care Improvement Task Force befo re embarking on motherhood.