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The group developed a care approach known as “managed competition,” in which regulations were intended to work in tandem with the market to contain costs.

After Mr. Clinton’s election, Dr. Ellwood, the economist Alain C. Enthoven and others devised the blueprint for the administration’s “managed competition” health reform proposal.

“The best outcome for U.S.-China relations is likely managed competition — an accommodation that avoids military conflict while allowing for limited cooperation,” it reads.

The Nations League may feel like a lukewarm, managed competition for those on the outside.

If the exchanges represent the best managed competition can do, it’s no wonder many have concluded that the smarter move is to further expand public insurance programs, as we’ve been doing for decades under Democratic and Republican administrations alike.