The New Reality

As the nation lurches into a retooling of its health-care system, the people who work at community hospitals are worried. Bob Blabey and other Stamford Hospital physicians are skeptical of Clinton's plan: They support universal access, but they believe quality of care may decline sharply. Sue Worland worries about that, too, though she says it will happen "over my dead body." Administrators wonder whether the mechanisms created by states to manage the new enterprise will resemble the hulking Medicare bureaucracy more than a streamlined, efficient delivery system.

With or without political reform, hospitals are losing their traditional power to determine how patients will receive care. Instead, as insurers and employers form alliances and capped payment systems force care providers to accept flat annual per-patient fees, hospitals will increasingly find themselves at the bottom of the industry food chain.