Merging HMOs into an all-payer system: a model to pursue?

An almost unending debate over the future shape of America's health care system increasingly focuses on the continuum between managed competition and government regulations, and the question: What is right for the United States? The Maryland all-payer, rate setting system for its 50 hospitals, where over a third of the state's population is enrolled in managed care plans, is used as an example of relatively successful blending of competitive and regulatory strategies. This article concludes with the theme that given America's penchant for compromise, competitive and regulatory approaches can coexist in a pluralistic health system that constrains the use of services and costs, and enhances access and the quality of patient care.