Describing the U.S. health care system meansdescribing managed care under commercial forces. Managed care creates new moral tension forpractitioners, but more importantly, in its currentform it intensifies the commercialization of healthexpectations and interactions. The largely unregulatedmarketing of health services under managed care hasbeen a major factor in the increasing number ofuninsured citizens, while claims for cost reductionthrough managed care are equivocal. Risk-ratingpractices integral to the current medical marketplacethwart concerns for justice in allocation and createvulnerabilities for almost everyone. Thepolitical-moral concern of (...) the early 1990s for a rightto health care is nowhere in sight. (shrink)