Introduction: Storm's Coming

It is a bit late for the weather forecast for health reform.

In October 2013 the leading edge and eye of the hurricane was here.  After many forecasters warned of it's approach to health care, some chose to evacuate (retire early), join group practices (shelters) and some persisted in their old ways, unable or unwilling to adapt.  The tidal surge removed most of the laggards.

In health care the mantra "Move ahead or face extinction" has become reality Those who chose to change are still working as physicians.  Some medical practices faced insovency and ended in bankruptcy.

Nicholas Negroponte, co-founder of MIT's Media Lab quote:  "Computing is not about computers anymore, it is about living".

The storm eye is the affordable care act....a low pressure area with cyclonic winds drawing in each  component of the American health systemm. In the cyclone are violent thunderstorms and tornados..  These analogies are the large group and integrated health systems.  Unlike individual and small group entities they carry more weight and influence on the storm.  Each has it's own  niche in  the system.

The storm effects the entire country to it's core, economic, social and health.  The storm is about human survival, much like a hurricane bearing down on the community (metropolitan, or rural.). The most vulnerable are those living in the lowlands, near the ocean.  This  demographic is most vulnerable and require the most protection from storm surge and strong winds. They are  also   the least influential and require special protection as the storm advances.

These analogies are a powerful vision of what is and has taken place during the last four years.  The uninsured have been the center of this storm.  The effort to include them in our insurance system has effected the entire system.

The sheer  number, to include 40 million is an almost overwhelming increase in patients.  In practical terms resources are limited. The administrative burden (which includes planning and implementation of new organizations, financing...regulation, delivery of care and the change from fee for service to quality-based and value are considerable.