In the new, incremental politics of health care, managed care (for the insured) is demonized and patients' rights are protected, while concern about the uninsured remains marginal. Quality of care is now the issue: consumers want choice restored in the medical marketplace, and physicians decry their perceived loss of professional autonomy. The managed care revolution, inspired by the private sector to contain costs, has stalled - the upward trend in medical spending is reasserting itself - yet America's liberal political system seems incapable of comprehensive health care reform. Why? At root, it is the limits of liberalism itself. To the extent that liberalism is wanting when deliberating about health policy, other ways of thinking about health care must be found. This article traces the shape of one such alternative - the political common good - and argues that the Oregon Health Plan - an innovative and controversial effort to provide Medicaid coverage to a greater number of Oregon residents - while imperfect, highlights the potential political common good thinking has in overcoming many of liberalism's limits. The article begins by discussing the limits of liberalism within the health care context. Part I introduces the question against the backdrop of President Clinton's failed health care plan and offers the political common good as a fresh way of thinking about health care. Part II explores two distinctive features of anti-perfectionist liberalism - loyalty to the individual and emphasis on neutrality. In doing so, it explains why a liberal paradigm is incapable of providing a coherent theoretical framework for promoting health care reform. Part III explores three different conceptions of the common good. First, it examines the common good as presented in recent Catholic social teaching. Next, it summarizes John Rawls' conception of political liberalism, with particular emphasis on public reason and the common good. Finally, it defines a third conception - the political common good - and argues in favor of adopting this as a more robust theoretical foundation for political discourse on health care reform. Part IV uses the Oregon Health Plan, enacted in 1989 and implemented in 1994, to point out the potential of understanding health care as a political common good. The article concludes by speculating about what a rescue of common good-talk would add to deliberations over health care policy.

The trend toward managed care presents promising opportunities for improving the health of large populations. Capitated financing arrangements and performance-based reimbursements, in theory, create imperatives for these plans to promote behavior that reduces health risks and to emphasize preventive services that may forestall costly future medical treatments. By extension, healthier communities minimize the assumption of risk and medical resource utilization, particularly as new members join a particular health plan. Managed care can further improve the health of the nation by eliminating a serious structural deficiency in public health. These organizations, rather than governmental public health agencies, are more closely associated with the health of the people and, thus, are better positioned to observe and influence personal behavior, identify clusters of diseases and injuries within the enrolled population and, through investigation, find out what caused them. The authors suggest that the private provision of certain public health functions such as clinical prevention and personal medical services should result in efficiencies and cost-savings, thereby allowing public health to fulfill its quintessential role of developing population-based strategies to identify health risks and to improve behavioral, environmental, social and economic conditions that affect the health status of wider populations. A recognition of managed care's stake in public health does not, however, resolve the complex issues of how to achieve a redistribution of resources to focus more on prevention and community public health services. The reality is that managed care's norms and practices emphasized short run profits, while returns on investment in community health are profitable in the long run. The authors conclude that the basic power or obligation of organized society to protect and preserve the health of populations justifies government action to change the incentive structure. Through well-conceived delegations, incentives and regulations, managed care can complement government public health activities to maximize societal welfare. Further, the authors argue that managed care organizations have independent social and ethical obligations to add a community component to their activities.