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March 1980 (Volume 58)
Theodore R. Marmor
James A. Morone
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The health planning legislation of 1974, establishing HSAs, represented an important attempt to break recurring patterns of decision making in public choices. One widely heralded strategy for controlling contemporary medical care-consumer involvement through accountability, representation, and participation-is flawed by failure to recognize that political markets are always imbalanced because of unequal interests and disproportionate resources. How can we represent broad, diffuse interests when all the incentives point to domination by a minority of intensely interested producers? Solutions favored at the local level may not best serve the entire nation; they cannot mirror the full spectrum of constituencies. Adjustment of mechanisms both internal to HSAs and external to them are suggested-yet, even so, their mandate reaches beyond possibility of accomplishment.
Author(s): Theodore R. Marmor; James A. Morone
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Volume 58, Issue 1 (pages 125–165) Published in 1980
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.