Changing perceptions, changing reality.

Abstract

It should come as no surprise that Americans are deeply troubled about the ways in which we receive health care. We are worried about what analysts call “health care delivery and finance,” that is, where, from whom, under what conditions, and with what financial implications we obtain health care services. We have all been participants in, as well as witnesses to, a revolution in the ways we intersect with an important social service, one that has significant implications for our well-being and carries with it extensive emotional baggage. It is understandable that, finding ourselves in the midst of a revolution, we would be confused and frightened. We wonder what will happen when we turn to the modern replacement for the traditional and familiar Blue Cross–Blue Shield plan or similar arrangements we thought we understood. We do not really grasp the changes in Medicare, such as the differences between “Original Medicare” and “Medicare+Choice” and the various arrangements possible under the latter, such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), provider sponsored organizations (PSOs), private fee-for-service plans (FFSs), medical savings accounts (MSAs), and religious fraternal beneficiary plans (RFBs). We are concerned about the development of new, merged, sometimes for-profit, hospitals. We are troubled about the fact that our physician, now an employee of an HMO and subject to its rules and regulations, seems busier and more rushed.