In 1999, Relman participated in a Harvard Medical School debate on the subject of unionization of physicians and for-profit health care. His stance was described:
"Although he believes that managed care is here to stay, the current 'marketplace' state of health care is not viable. In order for the system to work, it is going to have to be 'not-for-profit, community-based, and run by doctors and local health care institutions with the support of community groups.' Keeping the big picture in mind, Relman said, 'Unions are unnecessary in a not-for-profit sector.'"