There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries … and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.
– Niccolo Machiavelli, The Prince
Mindful that the Senate has yet to vote on the reconciliation package, one cannot deny that we are near the end of the beginning. The work of animating the words on the legislative page and applying them to this country’s fragmented, proprietary, volume driven, risk aversive system must begin.
Can doctors lead? In many ways the medical profession gave up the reins when they allowed HMOs to assure them stable volumes and regular payments. Since then, the business of insurance and the business of medicine have been locked in a battle for the patient’s health care dollar. Insurance likes you when you are healthy, medicine likes you when you are sick. After all, “health insurance” is really sickness & accident insurance. Continue reading