There was a time when commentators confidently predicted that Bill Clinton's presidency would stand or fall according to the fate of his administration's ambitious program for reforming health care to guarantee all Americans coverage. That's coverage, remember, and not mere access, as I recall Hillary Clinton stressing in a November 1993 speech that drew sharp distinctions between the Clinton plan and the comparatively milder reform packages offered by Republican Sen. John Chafee of Rhode Island and Democratic Rep. Jim Cooper of Tennessee (packages that look fairly gargantuan in retrospect).
As Americans decide whether to renew Mr. Clinton's lease on the White House, that prediction looks silly. Clinton is way ahead in the polls, and the Clinton plan's loud Capitol Hill belly flop is just something Sen. Dole tries to remind us of. (He's quieter about his own onetime soft spot for the Chafee Plan.)
Luckily, it isn't this magazine's business to read the larger tea leaves. We needn't even decide whether the pollsters are right this time or are headed for a November surprise. But there are aspects of the future we must discuss if we're to do our job. We can only hope to avoid the embarrassment that befell those publications that in 1993 sagely spelled out what would happen "when" — not "if" — comprehensive health reform was enacted.
You'll find four reasonably safe predictions in this issue of Managed Care. Quality measures promulgated by the National Committee for Quality Assurance — and others — will become more demanding. Traditional episodic, fragmented care will give way to "disease management" strategies targeting particular conditions. If medical savings accounts become popular, managed care organizations will find a way to work with them. And finally, the days of keeping clinical data on paper charts are numbered.
The fun, of course, will come in those further developments we can now in no way foresee. Have a pleasant October.