For a time, the experience of one community, Rochester, New York, seemed to belie this indictment of the nation's health care system. Rochester's community effort was singled out for praise by William J. Clinton in his 1992 campaign for president. “If Rochester, New York, can do it with two-thirds of the cost of the rest of us, America can do it too. I'm tired of being told we can't. I say we can. We can do better, and we must.”

Such commendation, for containing costs and providing access to health care, reflected the success of a collaborative, global budgeting demonstration by nine Rochester-area hospitals during the decade of the 1980s, the hospital experimental payment program (HEP). Yet Rochester's glory was short-lived. When the experiment concluded in 1990, competition had already begun to replace collaboration. Then, throughout the 1990s, hospitals vied with each other for patients and for physicians’ practices; at the same time each sharply increased spending on capital improvements and technology. By 2001 one of the nine hospitals in the HEP consortium was closed and another no longer functioned as a full-service community hospital. Rochester's unique status among American communities seemed to be over.

The hospital experimental payment program began on January 1, 1980, as a two-county demonstration in the Rochester area of western New York State, designed to test the proposition that a community on a voluntary basis could more successfully control the rate of increase in hospital costs, improve the efficiency of hospital services, and maintain or improve the solvency of the participating hospitals than under New York State regulations. HEP was made possible by waivers from Medicare and Medicaid by the federal and state governments, and the participation of Blue Cross of Rochester.