Background

It is clear that the U.S. Health System is in crisis and is long overdue for reform or transformation. There are five main scenarios that American society may follow in regards to the evolution of its health system.

 Continued Laissez-faire Market-driven Evolution, Continued Failure of Reform
 Collapse of Laissez-faire Market, Failure of Reform
 Universal Medical Coverage Under a Comprehensive Health Plan
 Incremental Reform (e.g., extension of Medicare to children)
 System Transformation to a Proactive Consumer-driven System with a Robust Resilient Public Health 3.0 Infrastructure, and Far More Emphasis on Prevention

It is too early to be able to forecast which scenario will ultimately play out in association with another move toward health system reform / transformation during the Obama Administration. However, it is possible to outline some of the positive and negative attributes of the five main scenarios and understand elements of their resilience in protecting and improving the health of Americans over the next two to four decades.

It is feasible to understand and model the key stakeholders’ political and economic behavior. We can forecast with some certainty what types of legislative artifacts key stakeholders will insert into political agendas and public agendas that will shape the emergence of the dominant sustaining 21st Century US health system scenario.

It is critically important that the U.S. does not end up with a scenario in which the U.S. has a significant decline in its private health sector’s ability to meet the health needs of the American public, while sufficient reform or transformation fails or is enacted too late to avoid a collapse in the U.S. health system. In addition, it would be best to avoid another round of failed health system reform. The other three scenarios of Universal Medical Coverage, Incremental Reform, and more fundamental Health System Transformation are all legitimate, and some would argue, essential elements of this round of the health care reform discourse.

The legislative process can, to some degree, be forecasted based upon the last rounds of health care reform within the United States and in other countries, taking into consideration the current legislative proposals, stakeholder analyses, and the social, economic, ecological, and political conditions that will play out over the next two years. It would be prudent to prospectively simulate and anticipate the dance of legislation that can be expected over the next year and a half, based upon multiple socio-political-economic landscapes to better understand how to shape the legislative process from the perspective of the Obama Administration’s health policy guidance and directives. The use of intelligent social networks, serious games, and the semantic web by various parties may change the discourse and outcome of this round of health care reform under the Obama Administration.

Ultimately, we have to recognize that what emerges as politically viable during the next seven quarters, before the next mid-term election, will be shaped by patterns of behavior and social processes that may not be well adapted to a resilience and sustainable U.S. health system that can optimize the health status of Americans in rapidly changing conditions during the first half of the 21st Century. The American Health System may be significantly impacted by long-wave phenomenon (e.g., economic depression, aging of the population), potential exponential shifts (e.g., global consumption patterns, climate change, peak oil, water availability), or discontinuous social patterns (shifts in culture, disruptive technology, collapse of institutions, war), which do not enter the health system reform discourse over the next 7 quarters. Yet, these factors could greatly impact the viability and resilience of the American health system over the two to four decades in which the reformed/transformed system will have to address the health needs/demands of the American public.

Those economic conditions and global change parameters that are considered within the simulations of the U.S. health system performance over the next two to four decades, as well as the more incremental economic and socio-political processes shaping the health system reform process within the United States over the next seven quarters will define the final legislative product that will succeed or fail in Congress before the mid-term election. However, there is a possibility that the health care reform legislation could evolve without consideration of larger socio-ecological trends, with politically viable solutions being rapidly overwhelmed by events beyond the scope of the health care reform discourse. Ideally, health care reform simulations will be carried out with the intention of creating a resilient U.S. health system (fully considering the potential long-wave, exponential, and discontinuous economic social, and ecological backdrops) which can optimize the health of Americans for the next two to four decades.

Within this scenario, the broader capacities of U.S. society, not just actions by the federal and state governments should be considered and shaped in proposed health system transformation legislation. This broader health system transformation process would be designed to help maximize the health, quality of life, and functional life capacities of Americans over the next quarter century or more -- for the good of each individual, their communities, and the broader American society. It would put significant emphasis on new models of management and governance enabling agile social and economic processes that can optimize further system changes on an ongoing basis, capable of adapting to significant shifts in the broader economy and socio-ecological conditions.