Polk J J
Council of Smaller Enterprises, Cleveland, OH.
Manag Care Q. 1994 Winter;2(1):17-9.
The Clinton Administration's efforts at health care reform are somewhat hamstrung by a lack of working analogues, i.e., a scarcity of examples of what effective reforms might look like. While several excellent models of effective small group reform exist, the environment in which these living models operate and the tough decisions they have made to adapt to respond to the environment, have rendered them less than perfect. Rather than rely on these working models for guidance on both the promise and the limitations of health care reform, Administration officials appear to have chosen instead to highlight the models' inadequacies and discuss in a very general way how a government-based model might perform better. Instead of being guided by existing reality, government officials have chosen to attempt to reinvent it. The experience of one of the nation's largest and most successful purchasing cooperatives shows that workable reform will come not from broad vision or elegant models but from obsessive attention to the details in the real world.
克林顿政府在医疗保健改革方面的努力，因缺乏可行的类似模式而在一定程度上受到阻碍，也就是说，缺乏有效改革可能是什么样子的实例。虽然存在几个有效的小型团体改革的优秀模式，但这些实际模式运行的环境以及它们为适应环境而做出的艰难决策，使它们并不完美。政府官员似乎没有依靠这些实际模式来了解医疗保健改革的前景和局限性，而是选择强调这些模式的不足之处，并非常笼统地讨论基于政府的模式可能如何表现得更好。政府官员没有以现有的现实为指导，而是选择试图重塑它。美国最大且最成功的采购合作社之一的经验表明，可行的改革并非来自宏大的愿景或精妙的模式，而是来自对现实世界细节的执着关注。
