The Future, Whatever It Is, Is Seldom What We Expect


A lot can happen in a short time. As I write this, President Clinton has just delivered his State of the Union address. A White House summary of his health care proposals is encouraging: putting the strongarm on tobacco companies to shield youngsters from being recruited into the ranks of smokers, passing a managed care consumer’s “bill of rights” and boosting the National Institutes of Health budget for biomedical research $1.15 billion this year alone.

Who would have thought, four years ago, that cigarette manufacturers would be so clearly on the defensive, that state and federal government, so typically beholden to big contributors, would be so activist?

Who would have thought, four years ago, after the “managed competition” fiasco, that Clinton would be re-elected so easily? Or that he would now be waist-deep in a sex-and-subornation scandal?

Writing on deadline two weeks before we mail this issue, and knowing that a lot can happen in a short time, I wonder whether the president will be cleared dramatically or damned conclusively before we publish. Last month, when we sent out the January issue with its cover story on physician practice management companies, the MedPartners/PhyCor deal that we mentioned prominently broke apart as the presses were rolling.

In the ’90s, a lot has happened to change the financing and delivery of health care in a short time, and just as in politics, it doesn’t do to apply much certitude when looking very far into the future. But to fail to look, that’s even more foolish.

When I look, I see continued government activism in reaction to managed care’s failure to effectively police and promote itself. If it could do both, consumers would be reassured, the conservative Congress would back off and physicians and plans could get down to business–together. A lot can happen in a short time.

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