The Public Interest

The cultural revolution in health care

Ronald W. Dworkin

Spring 2000

THERE comes a time in any industry when the principles that have long governed its activity and operation no longer apply. A change occurs in the minds of the people who deliver the service, and though they continue to go about their work in timely fashion, they grow doubtful and frustrated about the way things are moving. They carry on with less conviction; they grow ill-tempered; the office environment becomes a very uncomfortable one. In the same way, consumers grow nervous and dissatisfied. They complain to friends in their immediate circle, and the only thing that keeps them from acting on their dissatisfaction is that they do not know whom to blame. Though the industry in question does not actually come to a standstill, a feeling of confusion and general gloom permeates all activity associated with it.

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