Though we've held it off for as long as we could, 2008 will soon be upon us. This thought sparks anxiety, and not only because we haven't yet thought about holiday shopping. We all need to think about 2008 and the effect that the presidential election will have on managed care. As our political story on page 38 points out, insurers might want to join in the national debate concerning the industry's strengths, weaknesses, and future.
It's one thing to contribute to the candidates who back your agenda, but it isn't just about getting those candidates elected. More important, in the long run, is influencing the terms of debate. It seems that there is a groundswell of interest in making sweeping changes to the system. That smoke has risen before, with little fire behind it. But don't assume that it will be the same in 2009, when legislation is most likely to be enacted.
Whatever happens, there will be an important place for managed care. The industry's job during the national debate is to help the public and policymakers understand the processes, principles, and successes of managed care and to counterbalance less principled reformers who emphasize anecdotal reports of managed care's misdeeds.
Our cover story on page 22 is about innovations brought about because of influential experiments in consumer-directed health care. This is an area in which the marketplace is working overtime to cope with the cost problem that is one of the drivers of the reform movement. Unfortunately, this focus on consumers will not bear enough fruit in the next year to have much effect on the policymakers.
Access is the other big issue. America's Health Insurance Plans has a full-coverage initiative that has the virtue of being incremental and therefore acceptable to many stakeholders. Will a complex and incremental plan appeal to voters and legislators?