MANAGED CARE October 2004. ©MediMedia USA
Brace yourselves. The election sprints toward its finale and it seems as if, regardless of the winner, the country will enter a dynamic period. Issues, foreign and domestic, could reach a point where a course is chosen that breaks with the evolutionary progression that has gotten us here. That's domestic, as in health care.
Is managed care analogous to an inventor in the 1870s laboring over a system by which gas street lights might be turned on automatically just as a figurative light bulb goes off over Thomas Edison's head? Our cover story [1] offers some hope for the managed care traditionalist. Contributing Editor Martin Sipkoff reports in detail on the argument, which I find persuasive, that allowing people who are sickest to pay less for drugs is not only humane, but makes good business sense. This could be a great step, but who can be sure?
In the Aug. 23 issue of the New Yorker, Adam Gopnik — reviewing recent books about World War I — discusses the struggles that we amateur and professional gazers into crystals confront.
All these historians find themselves contending with the issues of historical judgment: how much can you blame the people of the past for getting something wrong when they could not have known it was going to go so wrong? The question is what they knew, when they knew it, if there was any way for them to know more, given what anyone knew at the time, and how in God's name we could ever know enough about our own time not to do the same thing all over again. Or, to put it another way, are there lessons in history, or just stories, mostly sad?
We can only end as we began: with a warning. Brace yourself.