Discussions of managed care frequently begin and end with an opposition between the Hippocratic ethic of dedication to patient welfare and a business ethic of self-interest in the service of efficiency. Mary R. Anderlik approaches managed care as a problem of organizations. Rejecting a simple "medicine vs. business" analysis, she directs attention to management as manipulation, the neglect of such personal goods as satisfaction in professional accomplishment, and organizational moral myopia.

In this account, "pragmatic" suggests practical idealism, not the jettisoning of principle in...