MANAGED CARE December 2005. ©MediMedia USA
The Declaration of Independence, that audacious document, contains the remarkable phrase: "All men are created equal." No one believed it for a moment, not even Thomas Jefferson, who quickly, in the next phrase, cites the "Creator" as the basis of this equality. Only in the eyes of God can this be true, for certainly, in the eyes of Charles Darwin and, today, in the eyes of any biologist or physician, it just isn't so.
The story of health care is a chronicle of just how unequally we are created. Genetics can now dig to scary depths to make that point. At the same time, the consumer-directed health care movement pretends that Jefferson was correct all along.
As our cover story  points out, Darwin has not been silenced. The survival of the fittest applies to just how much control individuals can exert over their health coverage benefits. The story asks how can you expect the 90 million Americans with limited literacy to navigate the complex shoals of health care. Further, what will that ignorance wind up costing the rest of society in the long run?
Evolution is a blind machine that doesn't pause to ask questions. So, too, is the marketplace. Ready or not, consumer-directed health care is coming. Health plans and all other players in the system must figure out a way to break information choice down to the "See Spot run" level.
Meanwhile, we wonder. Did the dinosaurs of millennia past think, in any sense that a human identifies thought? Not too likely. They just looked stupidly at the sky as the streaking asteroid hurtled toward their home.