Let's say I have an hour to kill, and my alternatives are enjoying a cheese-laden pizza while reading, say, that wonderful David McCullough biography of Harry Truman or heading down the road to my health club for 60 sweaty minutes of huffing and puffing in the company of guys with telephone-pole arms who noticeably snort when they have to set the whatchamacallit back from my 20 pounds to their 150.
I'm no masochist, and I know mortality isn't mutable in the long run anyway; the mozzarella wins by a country mile. But it could be argued — a bit simplistically, of course — that American health care's ultimate challenge is to induce me to wait till bedtime for Harry, and instead to endure the ministrations of those oh-so-friendly health-club helpers who I suspect are dying, underneath their salesmanship smiles, to act like my old shaming gym teachers.
It happens that I do become eligible for a partial rebate on my health club membership fee from my HMO if I do something-or-other — jump through hoops, I think. But with me feeling just fine, thank you, and my heart attack not scheduled until 2014, thousands of pizzas from now, can anyone really influence my behavior in my own long-term interests when their only ally is my conscience, which has a campaign record approximating Tom Dewey's?
There is, of course, big money to be made and great good to be done in helping me limit my pizza-parlor hours between now and 2014. In a way, it's the whole point of managed care. But my HMO's exertions in the matter will naturally be limited by its own stake in me, and our affiliation may not make it past next Dec. 1, when my employer must decide whether or not to renew, to say nothing of 2014.
Managed Care's cover article, on page 30, tackles this bedeviling contradiction at managed care's heart. And on page 53, on this topic and others, we let our readers "give 'em hell."