In his revised Foundations of Bioethics, Engelhardt has provided a rich and far-reaching account, not just of the moral foundations of bioethics, but of their implications in a wide array of areas. From issues of birth, life, and death, to defining the concept of disease, to patients" prerogatives in choosing and refusing their health care, to the shape and future of the nation"s health care system, Engelhardt offers a coherent picture of the ways in which particular controversies should be addressed. Even the most comprehensive account, however, cannot discuss every issue. This chapter takes up a significant challenge in the changing economics of health care, one whose resolution has already begun but whose future directions need careful consideration. The chapter is not a critique, but rather an extrapolation of the ways in which Engelhardt would probably regard this issue.