there has been an overwhelming concern as to the status of the present health care system. Approximately 100,000 people lose their health insurance each month. Unfortunately the present system does little to aid these people. It is for this reason that various managed health care plans have come into existence. Managed health care is a system by which an outside body, such as a state or places regulations on the health care process. St. Luke/ Roosevelt Hospital in Manhattan is currently operating under a managed health care plan. Vickie Powell, In-patient Pharmacy Supervisor at St. Luke/ Roosevelt states that the approach to managed care in the hospital involves a "Gatekeeper" mechanism. According to Powell, each patient is assigned a gatekeeper, a general practitioner who will decide if the patient is in need of a specialist. If so the gatekeeper will make a referral to a specialist. Providing the patient chooses to follow the gatekeeper's referral he/she will be granted the health care benefits covered under the managed health care plan. If they are to go against the referral and see a doctor not recommended, they do not receive the coverage that they would under the plan. When asked how this would affect the pharmacy aspect of the hospital, she said "Pharmacy must become involved in the schooling of the patient about the medicine, where this was previously the job of the nurse." Besides this, she says, it would not have a great effect on her department as opposed to the hospital as a whole. The Managed Health Care Plan has received the most publicity from President Bill Clinton. His plan calls for universal health insurance, meaning that no one could be denied coverage. When faced with the question of what happens to someone coming into the hospital without any health insurance, Powell said, "A person can't be turned away from the emergency room with or without insurance. This causes a large deficit for the hospital." One of the major problems that most critics see with Clinton's plan is that it attempts to provide universal insurance without placing limitations on who can receive certain types of care. These limitations are present in the European, and Canadian plans that Clinton's emulates. An example of such a limitation is dialysis treatment. In the other countries only people under the age of fifty are eligible for coverage on this expensive treatment. Ms. Powell does not see any way that the Clinton plan could go into effect without implementing such limitations. A vast majority of Americans see a need for reform in the health care system especially on the hospital level.