For most of the 70s and 80s, the East was considered to be the center of hospital rate regulation and the West the center for free-market competition. Managed care in the East was "home grown" and large, national public companies generally stayed away from these markets. But, in a fascinating shift amid a great deal of turbulence, the East is starting to look at lot like the West. Economics are driving reforms and the best move for lawmakers is to stay out of the way. The train has already left the station. Perhaps the most frightening thing about the most recent Group Health Association data is that the President comes from a state with less than 3% HMO penetration. Many of his trusted advisors come from that state, including physicians who report on the home front.
在20世纪70年代和80年代的大部分时间里，东部被视为医院费率监管的中心，而西部则是自由市场竞争的中心。东部的管理式医疗是“本土发展起来的”，大型全国性上市公司通常远离这些市场。但是，在诸多动荡中出现了一个引人注目的转变，东部开始变得很像西部。经济因素正在推动改革，而立法者最好的做法就是不要干预。火车已经出站了。也许最近团体健康协会的数据最令人担忧的是，总统来自一个健康维护组织（HMO）渗透率不到3%的州。他的许多亲信顾问都来自那个州，包括在国内汇报情况的医生。
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