ABSTRACT
This chapter explores some administrative challenges of the Clinton plan by contemplating structure, technology, and environment. American political culture, which distrusts both government in general and the elected politicians who run it, reserves an especially hard place in its heart for appointed officials—"bureaucrats"—who apply the dead, heavy hand of public regulation to citizens who cannot hold them directly accountable. Ironically, organizational technology may be as challenging to the health plans as to their institutional superstructure. The health alliances are expected to be willing and able to monitor the plans in their portfolios and to ensure that they meet their budget targets while also maintaining access and preserving quality. One regrettable side effect of the upsurge in health reform sentiment is the assumption that health policy analysts can insightfully forecast the consequences of the numerous innovations proposed in more than 1,300 pages of draft legislation.
