Advocates for health care reform (representing a broad range of constituencies) raise serious concerns about the ability of managed competition to meet the health care needs of the American people. Similarities in managed competition proposals include establishment of a collective purchasing authority, creation of health plans, standardization of rules and requirements, and limitation on tax subsidies. Managed competition proposals vary as to whether they call for true universality, meaningful cost containment, and fair financing. The article raises questions about managed competition, including the technical feasibility; the link to employment; the role for insurance companies; severing the link between insurance and income, age, or health status; comprehensive benefits; cost containment; the role for managed care; universality of coverage; and the role for insurance companies to make treatment decisions.