Vanderbilt Law Review

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It is not the purpose of this Article to reject all features of procompetitive proposals. Competitive health plans, multiple health plan choice, provider and consumer cost consciousness, and antitrust activity all may have some place in a larger strategy to rationalize the medical care system. Each of the proposals has some advantages in terms of increasing consumer choice and altering the balance of power between existing actors. As an approach to universal medical care system reform, however, competition alone is inadequate. In fact, one could argue that the most technically feasible way to both rationalize the medical care system and reduce total societal expenditures on health would be to nationalize a public budget for health care and to pass the total costs of medical care through the political budgetary process. Total societal costs might actually be reduced by increasing the program costs to government, as long as public authority is, as in Canada, adequately increased. The centralization of regulatory and allocative decisions could well result in a more suitably restrained form of American medicine. That, however, is a discussion about the alter-natives to procompetitive proposals, rather than the problems of procompetitive proposals, and is therefore beyond the scope of this Article.