We do not provide a quote-of-the-week box. Maybe we should, though some tactical problems would have to be addressed. For instance would the quote be lifted from one of the hundreds of news outlets that run stories on health care each day? Or would it be something someone said to us here at this magazine?
If the latter, then the best feedback this week comes from Peter Kongstvedt, MD, a consultant with Cap Gemini who is quoted in our coverage of the latest Institute of Medicine report. In responding to whether health care in the past ever worked well enough to be considered a benchmark for present efforts, Kongstvedt says: "When was the golden era of any evolving organism? There's not such a thing. It's continually evolving. The environment changes, science changes, the economy changes, and we continue to evolve along with it."
Kongstvedt puts his finger on the difficulty of managing change. The IOM report in question, for instance, points out that, "For several decades, the health care needs of the American people have been shifting from predominately acute care to chronic care."
In its focus on prevention and disease management, some of managed care's goals dovetail with those of the IOM. The report highlights just how.
More change. Our cover story looks at what the new Republican majority in Congress, aligned with the Bush administration, hopes to accomplish in health care policy. There's much on the table and, as one expert puts it, probably only a year in which to do something. (Then comes election-year gridlock.)
In this instance, the amount of change will depend on just how much of a crisis politicians think the current system is in — and how much of an overhaul the public will accept. Memory never sleeps in the nation's capital and the Clinton health care reform debacle seems as fresh as yesterday.
One way or another, however, change is upon us. As Kongstvedt says, we will not be judged on how we stack up to 1950s-style health care. Rather, history will ask whether we proffered the unique answers to the unique questions presented to us.