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To the Editor: The American Heritage Dictionary¹ defines the word managed as "to exert control over." I propose that Medicare fee-for-service (FFS) medicine is not only managed care, but managed care's best model.

Fee-for-service Medicare may appear unmanaged: patients go to whatever clinician they want, who then bills for each service rendered or diagnosis treated; the bill is then paid by Medicare. "Unmanaged" may have described yesterday's Medicare, but not today's. Medicare is a managed care system, although differently managed compared with preferred provider organizations and health maintenance organizations. Were it not, Part A would already be bankrupt, and the Part B premium would have escalated precipitously.

But this has not happened. Instead, management of Medicare has slowed its growth rate to 7.2% in 1997 compared with 12.2% in 1994 despite increasing numbers of beneficiaries and costs of technology.² Furthermore, Medicare per-enrollee growth has trended downward in the last 2 . . . [Full Text of this Article]

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