As the decade of the 1980s comes to a close, medicine has seen a dramatic shift in the attitude of policymakers—especially the 535 members of Congress.
In the post-World War II era when America experienced unbridled optimism, world leadership, and a rapidly growing economy, the focus of legislative leaders in medicine and health was identifying problems and figuring out how best to solve them. If there was a disease that needed treating—a special institute—or at least a research program, was started. If there was an underserved population, a program to get services to those individuals was initiated. The results were spectacular. The National Institutes of Health became the world's focus for outstanding biomedical research, both basic and applied. Most health indicators of the population moved in the right direction, albeit not as fast as some would desire, and were still improving. Access to care was increased, greatly fueled by the