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Among various health cost containment strategies proposed during the 1970s, none has held more sustained fascination than the health maintenance organization (HMO). For many years, policy analysts in search of market- and incentive-based alternatives to “command and control” regulation have argued that medical groups combining prepayment and group practice, and offering comprehensive medical services within a fixed budget, would hold down costs both by their own efficient operations and by the competitive pressures they would apply to the conventional systems. During the 1970s, three presidents and five Congresses worked to formulate and implement legislation to increase the HMO presence...