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Managed health care is now part of the mainstream, with the majority of Americans insured under governmental or managed plans. At least 1 in 5 is insured under Medicare or Medicaid. Of those with private insurance, nearly 9 in 10 (88 percent) are in managed care, according to a July/August 2001 survey for the Henry J. Kaiser Family Foundation and the Harvard School of Public Health. A November 2001 Gallup poll found that a mere 15 percent of those surveyed had a traditional, fee-for-service insurance plan.

The move toward managed care has been rife with controversy and complaint. One-third of those surveyed by Kaiser/Harvard agree that people are worse off as a result of the trend (only 14 percent believe things are better). The quality of health care is criticized less than the actual health care coverage. In the November 2001 Gallup poll, 46 percent of Americans rated the quality of health care in this country fair or poor (compared with 53 percent who described it as excellent or good). At the same time, a majority (69 percent) rated the nation's health-care plans as fair or poor, with 30 percent rating them excellent or good.

The current level of disgruntlement is low, compared with earlier stages in the transition to HMOs, when dissatisfaction with insurance was more widespread. In a 1994 Gallup poll, 17 percent said the health-care system was in a state of crisis; in November 2001 only 5 percent agreed — although considering the survey followed so closely after Sept. 11, the word “crisis� was probably less readily used to describe health care.

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