(Zelman, 1999, pp. 5-6) Managed care, then becomes an institution that is highly in need of regulation, according to those who make such decisions, as the need to be a consumer advocate (including those who are profiting from health care) has always driven the government to act.

Lastly, the manner in which the managed care system has changed the way that sellers, in this case doctors, most of home have historically been in private practice, with clinical privileges to practice care in most of the local hospitals where they work. Doctors who have been in practice for years are seeking change and regulation within the managed care system, as many are reluctant to center their new lives around a salary and a job (as they were always self-employed in the past) where the intention of the dictated system is to reduce the amount of care, a reversal of historical precedence. The doctor and the patient are no longer allies in the fight against disease or toward health, now a perceived big brother makes many of the decisions. (Pauly & Berger, 1999, p. 71) the immediate result has been many individual physicians retiring early in the wake of many problems, prior to the managed care movement and after. The managed care system then relies to a great degree on new doctors or doctors who are actually relieved at the idea of losing a little autonomy to gain the benefits of a little protection, through employment.

So, in a sense the ownership of the title sellers has dramatically changed through the managed care systems and such entities, according to doctors, consumers and the government must be regulated, so as not to over-manage care to a point were patients are denied services because the system doesn't want to pay for them rather than because the system believes they are not necessary. Yet, the reality is that managed care is a for profit institution, just as the...

For this reason the defense of the system can lie only in its ability to provide better care for a greater number of people. Many would say that such care is what is needed today as driving cost of private care up so high was startlingly ineffective for consumers, the community, doctors and the government, in their bid to try to make the system that is in place, base don the "capitalistic" ideal of competition work. This reality remains to be seen, yet the managed care system seems to be stepping in the right direction, and away from early failures, toward one where preventative medication has been doubted as the way to reduce cost. If this bandwagon is actually the one the managed care system is on then the medical care in this nation will prove greater in the future, while if denial of care for the sake of cost is the bandwagon being hidden the system will likely continue to fail the country. (Folta & Scanlon, 2004, p.26)