Swan song. A disastrous decade bows out

The 1980s was a decade of disaster marked by three major themes. One was the idea of the market--the notion that economic principles such as competition, free-market pricing, deregulation, and consumer choice could be retrofitted to healthcare. The second featured myths that had little basis in reality but which were hauled out as justification for strange, destructive behavior. The third was the search for meaning in healthcare, which delved into the ethics and responsibilities of providers, policymakers, and patients, as well as the nature of healthcare. The results have not been all negative, however. A more careful brand of medicine is emerging--more conservative, more patient oriented, more sensitive, less cavalier. A more informed patient, who operates less on faith and more on questions, has already emerged. And hospitals, after a long sleep, have realized that their fate lies as much in the hands of the communities they serve as in the legislative halls of Washington or state capitals.