The Clinton health care plan was hailed by some, and criticized by others, but never made it to passage governmentally. It did, however, spur a reform within certain elements of the health industry to create their own incentives for change that directly impact health and exercise programming.

The Dean Ornish Health Heart Trial has been sponsored by Mutual of Omaha plan nation-wide. Dr. Ornish plans to expand his program in 1995-96 to over forty sites nation-wide. Fitness gurus Jack LaLanne and Richard Simmons have also been in negotiation with health insurers for senior exercise and weight management program reimbursement. This could have major ramifications on the concept of paying for long term lifestyle management through exercise and health education.

Other programs are springing up across the country are paving the way for the use of exercise and "wellness medicine" in hospitals and rehab clinics, as many HMO's (as mentioned), are paying for these types of prevention services.

Conclusions
It is estimated by leaders in the health industry that the next two years will show profound changes in the way exercise is viewed by both medical professionals and consumers. Relationships between fitness, health promotion, medicine, and the insurance industry will become closer. There will also be a "weeding out process" for those in the field who do not understand coming trends, and are able (or willing) to make necessary changes within their businesses in order to survive within tomorrow's health care and wellness markets.

For those who are planning for the future, it looks bright. Perhaps the benefits will be seen within the next year, as more exercise programs are formed with medical practices, and deals are made with third party insurers.

Practical Tips for Tomorrow's Health Consumers
1. Pick an insurance plan that provides health promotion as part of its basic benefits package. This will insure you some affordable wellness services through your work, or community program.

2. Pick a health club that offers alternative programs (weight management, nutrition classes, smoking cessation), in addition to basic exercise services. These are the programs that are reimbursable.

3. Ask your doctor for referrals in other areas of health (educators, massage, chiropractic, exercise). Also, choose another practitioner as your "secondary provider" outside of traditional medicine. In the future, they may be part of our allopathic health care system.

A Future Forecast For Health Promotion and Exercise
Within the next 1-2 years.

• Major contracts will be signed with HMO's by select fitness providers.
• Employers select insurance companies based on the inclusion of health promotion and exercise programs, and the potential cost savings to their companies.
• Outcomes reports will become standard to the first-line health clubs that do business in the health care arena.

• Consumers will be aware of medically-based health clubs through their work, insurance company, or through the media.
• Major contracts between fitness and insurance companies will be completed (no new programs will be incorporated).
• Certification will be mandatory for employment in the health club industry.
• Most (if not all) clubs will have programs for special/medical population groups.

• We may find physician offices (or branch offices) within health clubs.
• Large volumes of health research will come from the health club setting, as opposed to hospitals and universities.
• We may also realize Naisbitt's prediction of a potential $188 billion a year savings in health care through health promotion programs.