In Reply.
—Dr Farrell may not have understood the full implications of "market dynamics" in the title of my article. Like "Old Man River," the dynamic of a market is just to keep rolling along, which is why Farrell is correct in describing managed care as "a distorted solution to a distorted market."
However, most of the distortions in the structure of the health market are on the buyer side, not the provider side of the market. The lack of systematic assistance for improving consumer know-how in purchasing health services and the failure of employer-sponsored insurance to incorporate more directly consumer sensitivity to the costs of care are, I believe, the 2 principal remaining market shortcomings.
Managed care has not contributed to solving either of these flaws. Instead of helping consumers become knowledgeable about purchasing health care service, it has restricted consumer choices of allowable providers and therapies. However, by making employees
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