Editor's Memo

How Difficult It Is To Change Even an Unacceptable Status Quo

John Marcille

We can understand the frustration of Thomas Scully, the administrator of the Centers for Medicare and Medicaid Services and the subject of our Q&A feature this month.

In an article in this issue, Scully says that what has shocked him in returning to government service after 10 years away (he worked in the first Bush administration) is the familiarity of the debates.

"...Since I was last in the government, 10 years ago, nothing's changed," he says. Scully is referring to Medicare and Medicaid, pointing out that there's still no drug benefit for the former, and that states are still locked into old methods of distributing care for the latter. "We just haven't been addressing any of the big structural issues."

We'd like to point out that in the private sector, there has been change. We cite the rise of PPOs, the influence of disease management, and the growing belief by many that defined contribution's time has come. But even the marketplace has limits. Too much change is liable to create a backlash, brought to life by such films as John Q, which is discussed here.

Still, so long as the goals are healing and savings (but in what order?), there will always be enterprising people with enterprising ideas. Our cover story by Contributing Editor John Carroll looks at hospital tiers. If you were to give it a flippant one-sentence synopsis, it might be "John Q meets sober discussion on patient responsibility focusing on the hard truth that choice costs more." Now there's one film that will never be made.

Perhaps the most salient point Scully makes is that true change may take 20 years. Given the recent reports that the government deficit (Weren't we just talking about surpluses?) is expected to reach $100 billion this fiscal year, he probably has a point.

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