The prospect that health care markets, famously resistant to the iron laws of economics, might be "normalized" after all has attracted much attention over the last three decades. Managed competition, a strategy that spearheads this project, proposes to instill new efficiencies in health care systems, without damage to equity and solidarity, with a model that sets market forces within a framework of sophisticated rules designed to avert market failure. This paper seeks to explain why managed competition has found different degrees of favor in different health care systems by reference to cross-national distinctions in policy culture, organizational structures, and professional politics.