While noting that some of its features were consonant with the preferences of the profession for passage of a single-payer system, social work withheld official support.Despite the failure of Clinton's health proposal to win a majority in Congress, various aspects of managed competition began to permeate the health care field. Health care provider "report cards" based on quality and cost measures were publicized by insurance companies. Patients were encouraged to
use these report cards to select their doctors, hospitals, and laboratories. The stage was set for creation of a consumer-driven or consumer-directed health care system in which marketwise health care consumers were predicted to moderate overall costs in the U.S. health care system by using self-restraint in their individual health service purchasing decisions.
Computer technologies were increasingly claimed to improve efficiency, as Internet-disseminated provider report cards made more transparent the cost and quality profiles of the rated physicians and hospitals. Although the outcome data are quite mixed regarding the effectiveness of managed competition in restraining costs, many recent health policy proposals
continue to build on the 1980s and 1990s reforms just described.