The revolution that purchasers wrought in the health care market through their embrace of managed care in the late 1980s and 1990s now seems to have lost much of its momentum. In a relatively brief time, the apparent success of managed care models in curbing cost increases has completely dissipated. Provider and consumer objections and complaints about the strategies and tactics of managed care organizations have grown into a full-fledged backlash or counter-revolution. Policymakers and purchasers have responded by imposing new requirements and demands on these organizations that health plans contend curb their ability to manage both cost and care. In the near future, there is sure to be growing recrimination over who is responsible for the “loss” of cost containment. But irrespective of where responsibility ultimately is assigned, it is evident there is very uncertain support for a managed care model that is clearly at risk. As creations of the purchaser community, if these organizations fail to deliver the value for which they were created, they will be replaced.