Among industrialized nations the United States is relatively
unique in relying on a mix of public and private financing and
delivery of healthcare: federal and federal-state programs,
such as Medicare and Medicaid; employment-based health insurance
(primarily HMOs); and state-subsidized insurance pools for
high-risk individuals. In recent years, however, there have
been efforts to apply the principles of private employment-based
health insurance to the other forms of healthcare, and there
is speculation that rising healthcare costs can only be addressed
by further extending capitated payment plans. This suggests
that U.S. healthcare may increasingly be organized according
to market principles. For some, this represents a historic
departure from an emphasis on public responsibility for healthcare
and a sacrifice of the value principles embodied in health
relationships between patient and provider. But defenders of
HMOs and a larger role for markets argue that managed care allows
for a more rational allocation of scarce healthcare resources
by minimizing inefficient low-benefit–high-cost care.
More individuals receive essential care if inessential care
is eliminated. HMOs are also said to encourage non-HMOs to provide
lower priced healthcare.