well as it possibly can, to make up for information deficiencies and to help consumers to choose more wisely? Will it ensure that there is entry into and exit from the market that allows the kinds of choices to be made among options that otherwise might not be available if entry were limited? If the government's role is to help the market work well, what will happen when the market cannot work—when access is limited and certain people cannot get in? What will happen to education and to research—areas in which the market generally fails us?

Third, if government is to help ensure that the failures of the market are compensated either by making the market work as well as possible or by substituting for the market, there will also be a role in which government is the prudent purchaser from the market, whether we are talking about Medicare, Medicaid, the Department of Veterans Affairs, or the Defense Department. The role of government in the future will be an important one, even with a market-driven economy.

Much of the discussion in this session traces the boundaries between a market-driven economy in health care and the proper role of society as it is expressed through government. I anticipate learning about how that might help our institutions evolve. What might our institutions become in the future, as horizontal and vertical integration proceeds, as networks continue to be developed, as risk sharing leads to the need for information sharing, and as our relationships change? The latter include relationships between clinicians and their patients, relationships among different kinds of clinicians, and importantly, relationships among patients, clinicians, and their organizations.

In closing, let me offer an observation that I think is very helpful for those of us who are so much of this market and of health care that sometimes we cannot understand what is happening. Walter Lippman once said, "You cannot see the play and be in it." In this session, we hear from some people who are in the play, but who seem to be able to see it as well.

Cardinal John Newman once said that he did not have much use for all of this futurism: "I do not ask to see the distant future. One step is enough for me." However, in the current health care environment, one step might not be enough.



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