MANAGED CARE September 2002. ©MediMedia USA
Sometimes it is all I can do to keep from being totally discouraged about health care finance and delivery. Even the bigger efforts being made to reform the system are often double-edged swords. You want a Patients' Bill of Rights? I'll give you some rights, as long as you sign away your right to an unlimited jury award when there's malfeasance.
OK, that's the patient's point of view. But the industry point of view is reciprocal: You want a cap on jury awards? Give up some other "rights" to patients.
Journalists, of course, make more hay from bad news than good news, for many reasons. Honestly, most good news isn't news, as the many failed attempts to start publications dealing only in "good news" have shown. There's the added difficulty of whom to trust. When there is a disaster, you have no difficulty verifying it, but much good news is really PR, and journalists are paid to filter the jive from the gems.
Yet when I look through this issue of Managed Care, or indeed, any issue of Managed Care, I am somewhat heartened. All is not bleak. This month's cover story  by Contributing Editor John Carroll doesn't shy away from the tough issues dividing PBMs from their clients and from patients, but you know, the good news is that the issues are being discussed realistically (unlike, for example, the future of Social Security or the federal deficit or the effects of the recent tax cuts). PBMs, I have no doubt, will be changed by this crucible they are in now, they will survive, and the system will be improved.
I am heartened by Contributing Editor Bob Carlson's look at medical education . After a decade of talk, real efforts are being undertaken to teach med students about how the health care system really works, why guidelines are needed, what "evidence-based" means, and many other aspects of current practice. Even the chart that shows the number of prescriptions rising  heartens me — people are getting better care, you can be sure — even if our total spending on drugs is rising faster than other components of the system.
Today, at least, my glass is half full.