That's the question on the minds of healthcare executives as they try to make sense of the confusing developments surrounding healthcare reform in Washington and in many state capitals.
As our cover story by Washington Bureau Chief Lynn Wagner points out, President Clinton's reform plan, as written, is dead. RIP. The plan was done in by its complexity, by its regulatory tone and by the administration's failure to develop a public and industry consensus about the kinds of changes that might be palatable.
The first congressional effort to tackle reform also has bogged down in the House Ways and Means health subcommittee. Meanwhile, states such as Florida and Minnesota that have assumed a leadership role in widening access to healthcare are pulling back after discovering that their ambitious reform plans are proving costly and burdensome.
After a furious rush toward change, this pause in the action shouldn't be viewed negatively. In fact, it gives the industry an opportunity to continue on the path of evolutionary change.
Within the past few weeks, for example, provider consolidations were unveiled in Baltimore, Denver and Indianapolis. Such affiliations are just a beginning.
Executives who wish to create effective delivery systems must expand their notion of "community" beyond their immediate neighborhood. Working with health planners, physicians, clinics, payers and patients, they can focus on prevention and develop clinical pathways to improve the health of the population of their region. Such integrated efforts will help providers compete with other successful regional systems.
Changing a trillion-dollar healthcare industry that represents one-seventh of the nation's economy isn't a job for bureaucrats. Hospitals and physicians prepared to assume the financial risk of treating all patients can best decide how to allocate scarce dollars.
Meanwhile, Washington policymakers can build consensus around widely agreed-upon provisions such as insurance and malpractice reforms and can work to develop a realistic, long-range blueprint for expanding coverage to all Americans.