Perfect Reform Storm: Impact on Physicians and Patients

In 1997, Sebastian Junger, an author and journalist, wrote the best seller, The Perfect Storm, later a movie. The book told the story of fisherman off the New England Coast trapped by three converging weather systems.

Three Weather Systems

• Warm air from a low pressure system coming from one direction.

• Cool, dry air generated by a high pressure system coming from another direction.

• Tropical moisture provided by Hurricane Grace.

An Analogy

This is a good analogy for today’s perfect political health reform storm.

• Warm air, suddenly heating up as evidenced by the midterm elections, from a low pressure system coming from outside the Beltway, with conservative Americans calling for smaller government, less interference in their lives, lower taxes, less spending, less debt, and “taking our government back.”

• Cool, dry air provided by a high pressure, dispassionate, scientific, management-oriented Washington insider elites speaking in cool, dry terms about the need for a rational restructuring of the whole system from above.

• Tropical moisture (both sides claim the other side is all wet) producing a hurricane of opinionated bilateral rhetoric speaking in apoplectic and apocalyptic terms about the abyss that lies ahead if their respective opinions do not prevail.

Caught in the Middle

Caught in the middle of this perfect reform storm are physicians and patients who fear the worst, who feel they have no reform voice and no control over impending colliding weather systems.

• On the one hand, American health consumers have high expectations, fueled by the high tech performance of the current system, and the promise of a new entitlement system providing more care at lower costs. They expect the best medicine has to offer at more “affordable” price. These twin expectations are central elements of the perfect storm.

• On the other hand, a centralized government is saying the whole system must be overhauled and restructured, and physicians must offer less costly care under a system of expensive regulations with which they must comply at lower reimbursement rates without protection from tort reform.


• On the third hand, sometimes called the third or the center-right way, there may be a middle way out the storm, through disruptive innovations using cheaper care at decentralized locations, like the home, provided by less sophisticated personnel using electronic , and downsizing of the whole medical enterprise.

Time Not on Side of Those in The Boat

The problem with all of these scenarios is that with an imminent perfect storm, time is not on your side, the reckoning is at hand, and physicians in the boat with patients, must cope with the consequences – the impact of the perfect storm on their professional and personal lives.