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It’s a legacy system -- it’s got a lot of inertia. I think almost everybody knows,
even in corners of the country I would have expected to be more isolated, everybody understands
now the kind of care system we need to move to. It’s been remarkable to me to see how
widespread that understanding is: integrated care, seamless care, focus on patient safety,
containing costs but doing it by making processes more efficient. And I think, in general, wanting
people to have access to health care. But there’s stranded capital; we need to become
less hospital dependent, for example, in such a system. Hospitals have a lot of capital
invested and figuring out how to transit out of that structure is hard. There are labor-force
changes that we’re going to need to make much better use of non-physician providers
of care and the role of specialists will change. And most importantly, weaning us from fee-for-service
payment -- that’s going to happen at different paces in different communities around the
country. But we have entire structures of billing and business models and plans, board
beliefs, accountabilities which rest on fee-for-service and revenue-based care and that’s a very
different economic environment from one in which payment is more bundled and we’re
much addressing the needs of the patient no matter where they are.