Not too long after the election of Barack Obama as president in 2008 and the beginning of his administration in 2009, one heard the term “perfect storm” applied to the next phase of U.S. health care. However, this phrase implies a perspective that could have serious negative consequences, not the strong confluence of factors that could contribute to major improvements in the nation’s healthcare system. This confluence presents an opportunity for significant and comprehensive reform that has not been available for many years. Accordingly, in 2009 there was an intense nationwide expectation of change that closely matched the need for such change. The Obama administration’s initial response was to identify key healthcare principles that would guide its healthcare reform decision-making (http://www.healthcare.gov/):

We are no doubt in a healthcare crisis, one that has been going on for some time. Enthoven (2008) comments that “health care drained the federal budget of more than $1 trillion this year…. If present trends continue, in ten years the number will almost double” (p. WK9). He goes on to make clear that the only way to avert this increase in
cost is to change the way health care is organized. We have been in this place for some time; that is, unable to make the changes in health care that we need. Today, we have even greater evidence of the need for change:

President Obama’s move for healthcare reform was hardly the first on this topic. Senator Daschle provides an overview of the very long history of attempts and failures to reform health care—going back to the development of healthcare reimbursement in the early 20th century to later increased federal government roles through Medicare and Medicaid (Daschle, Lambrew, & Greenberger, 2008). His description is useful in assisting us to better understand healthcare issues. As Daschle notes, we have not been successful: “Our system is fundamentally broken, and decades of failed incremental measures have proven that we need a comprehensive approach to fix it” (Daschle, Lambrew, & Greenberger, 2008, p. xiv). He even describes the efforts as the “tortuous history of health reform” (p. 45). Why have we not succeeded in improving the system? Daschle believes the traditional legislative process cannot deliver the changes we need: It has failed many times to do so even when the broad framework of a plan is acceptable, which is described as “a public-private hybrid that preserves our private system within a strengthened public framework” (Daschle, Lambrew, & Greenberger, 2008, p. 107).