Since the defeat of President Bill Clinton’s health care reform package last fall, many have breathed a sigh of relief that we dodged a bullet. As Mark Twain once said about his death, however, the demise of health care reform has been greatly exaggerated. Profound reform, maybe even revolutionary change, touching every aspect of health care in this country—who performs it, what is done, how it is financed—continues to sweep the United States unabated. The transformation is called “managed care.”