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-- Head and Neck Surgery

The Times They Are A-Changin'

John H. Krouse
Otolaryngology -- Head and Neck Surgery 2014 151: 707
DOI: 10.1177/0194599814550782

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Editorial
The Times They Are A-Changin
I
n 1964, Bob Dylan released this timeless song on his
third studio album, also titled The Times They Are A-
Changin.1 The 1960s were a time of turmoil, of dis-
content, of challenging accepted norms and practices, of
promoting justice and equity, and of railing against war and
conflict. There was new hope for America, celebrated with
the election of John F. Kennedy, and the blunt realism of
lost promise that occurred on that fateful November 1963
day in Dallas. There were sharp contrasts between the easy
optimism of the 1950s and the tension of the following
decade. Discussions and demonstrations around civil rights
held center stage, and great speakers and leaders presented
eloquently their views for a new America. The nation and
its people truly were going through times that were a-
changin.
It was also a turbulent time for US health care. Prior to
1965, about half of Americans over age 65 had no health
insurance, and many others were poorly insured.2 Once
workers retired, many had no ability to provide health care
for themselves and their spouses. In recognition of this
social concern, Congress, under Title XVIII of the Social
Security Act, authorized Medicarea program of health
insurance for almost all Americans age 65 and over.
President Lyndon Johnson signed this act into law, and
effective July 1, 1966, Medicare became the largest public
program of health insurance enacted in the United States.
Under Medicare, the life expectancy at age 65 increased
and poverty decreased by half among the nations elderly.2
There were great debates at the time about the role of gov-
ernment in providing health care to its citizens and the
nature of how health care could and should be delivered and
paid.
Here we are again. We are in perhaps the most rapidly
changing period that US health care has ever experienced.
We are rekindling old debates about who should sponsor
and pay for health care, the role of government versus pri-
vate payers in providing coverage, and the size and nature
of social programs and their implication for American soci-
ety. Over the past 5 years, debates have been loud and often
acrimonious, with a government and a people polarized
over these critical issues. On March 23, 2010, President
Barack Obama signed into law the Patient Protection and
Affordable Care Act, also known as the ACA or
Obamacare, amid great fanfare but great partisan strife.
The implementation of this sweeping act of health care
reform has been rocky, yet all of us as physicians have
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Otolaryngology
Head and Neck Surgery
2014, Vol. 151(5) 707708
American Academy of
OtolaryngologyHead and Neck
Surgery Foundation 2014
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0194599814550782
http://otojournal.org
retooled and reconfigured and prepared for a future that
remains unclear. The one thing that is certain, however, is
that change is underway.
Beginning with a new section introduced in this current
issue, Health Policy and Economics, and in the coming
months, the journal will seek and publish papers that focus
on important topics in health care financing and organiza-
tion that impact all otolaryngologists. Success among oto-
laryngologists in the rapidly changing health care
landscape will depend on all of us understanding the speci-
fics of health care reform and leading the way for our sus-
tained role as part of the health care team. We will
examine health care structures, organizations, and financ-
ing and relate these issues directly to their impact on the
field of otolaryngologyhead and neck surgery. We will
solicit health services research that relates to the practice
of otolaryngology and lead the way in providing a venue
for investigations of health economics, patient safety and
quality, and evidence-based outcomes of the illnesses we
treat and the interventions we offer.
So, as it is clear that the only constant is change, it is
important that we keep otolaryngologists current with health
care reform and its implications. To those with vision, times
of change provide times of great opportunity. In our speci-
alty, we have the vision and the leadership and the commit-
ment to succeed.
Just as the journal has taken the lead on steering practice
through the dissemination of evidence-based guidelines
developed by our Academy, we also look forward to leading
this health care discussion through the publication of
impactful research and insightful reviews and commentaries
in this critical area.
John H. Krouse, MD, PhD
Editor in Chief,
Department of Otolaryngology/Head and Neck Surgery,
Philadelphia, Pennsylvania, USA
Corresponding Author:
John H. Krouse, MD, PhD, Professor and Chair, Temple University,
Otolaryngology/HNS, 3440 N. Broad St., Kresge West #300, Philadelphia,
PA 19140, USA.
Email: John.Krouse@tuhs.temple.edu
708 OtolaryngologyHead and Neck Surgery 151(5)

References 2. National Bipartisan Commission on the Future of Medicare.

http://medicare.commission.gov/medicare/history.htm. Retrieved
1. Dylan B.The times they are a-changin. Copyright 1963,
August 18, 2014.
1964, Warner Bros., Inc.

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