41.   Much of the lost business was with big companies that switched to insurers offering lower charges and managed care.

42.   Moreover, managed care programs have always provided emergency care when subscribers are out of their care area.

43.   Never mind that no hard evidence exists that American health care has actually deteriorated under managed care.

44.   Over the past two decades managed care plans have grown so rapidly that they now cover roughly two-thirds of all Americans.

45.   Patients now are generally sicker than in the past, before HMOs and managed care plans helped shorten patient stays in hospitals.

46.   Predictions that managed care would reduce emergency department visits and thus the need for emergency physicians have proved false, he said.

47.   Reinhardt worries that if managed care is further hobbled, the country will move to a two-tier system.

48.   Several other people said they did not like the idea that managed care companies could tell them to use different doctors.

49.   Some health care organizations acknowledge some naivete in embarking on Medicaid managed care.

50.   Soon letters will be going out to millions of HMO subscribers offering a glimpse of the new incentives by which doctors and subscribers will cooperate to manage patient care.