Biological regulation will occur whether we want it to or not; whether we are even aware of it. Nature and science do not assume their respective places around the negotiation table when health policy is considered. Any effective system must be functionally aware of biological and biomechanical realities. Every arbitrary simplification will be costly and ineffective to some degree; each will be costly, resulting in pain and suffering to some degree. Thus, any effective system, including payment systems, must be responsive and adaptable to nature.

In the early post-Soviet years, Poland, along with other countries in Central and Eastern Europe, looked at ways of combining public and private initiatives in health and medicine. This resulted in many awkward situations, as all aspects of health were not effectively supported with privatization and a push to open markets. In fact, one result was less of a sense of security and health by the populace. Before, health benefits, though imperfect, were at least available. With privatization, large gaps between needs and services developed. This was particularly problematic where perceived market opportunities in medicine existed.

Dr. Manicki was a consistent leader in the movement to retain a connection between public responsibility, science-directed regulation, and the application of medical services as a public good. This was demonstrated in an effective program for coordinating and centralizing payment processes, bringing public and private stakeholders together using integrated service models.