Abstract
The emergence of managed care raises new concerns about the ethics of health care financing and its impact on service delivery.The current outcry, however, fails to recognize that American health care financing has presented serious ethical dilemmas for at least 50 years. What follows is a historic overview of American health care financing, contrasted with current challenges. The intersection between ethics, economics, professionalism, and public authority is explicated, with a critical leader/advocate role for nurses presented.