Health care system reform.

While no one can predict with certainty the pattern of health care delivery and financing at the end of this decade, traditional providers, physicians, and acute care hospitals are reorganizing and regrouping in anticipation of major change.'There is also evidence that large health insurers are developing networks which integrate payment and delivery systems. 2 This article discusses some potential effects of President Clinton's proposal to reform the delivery and financing of health care on contemporary nursing education.This article will also offer a historical backdrop for the nursing community's reactions to Clinton's reform proposal by comparing contemporary responses to the positions of nurse educators during the last major revision of the health care system in 1965.3 Nurses were early and eager sponsors of Medicare and Medicaid because governmental assistance to the elderly, the disabled, and the poor was compatible with the nursing ethos.A 1965 statement of the American Nurses Association (ANA) linked ANA's obligation to ensure the quality of nursing services to its consistent support of the principles contained in the Social Security Act of 1965.1 In this statement, the ANA addressed three issues: education, economics, and utilization.The statement noted that Medicare's enactment would stimulate an increased de-* Sr. Mary Jean