Although I have been an observer of this scene since the mid-1960’s, when Medicare was first passed, and although I have been writing and speaking on this subject since the mid-1970’s, the following are observations and predictions prompted by the comments of candidates Peckinpawh and Courtney given at this weeks combined County Medical Association meeting in Westbrook. 

As Charlie Chan would say: “Velly Intellesting”. 

• The only thing that the candidates agreed on wholeheartedly was: “The Health Care System is broken”.  Really?  A convenient “straw man” to knock down, discard and build anew.
• Although physicians have been the target and favorite piñata of MCO’s, the American Hospital Association and our government, the clear attitude of the policy-makers now is that physicians are NOT part of the solution; they are part of the problem!
• As we have seen yet again during the last two years, physicians – “organized” or dis-organized – have no clout.  Only their patient – public have clout. 
• Patients will only mobilize when they feel their own pain.  
• That pain will come during the next few years, as Obamacare becomes fully effective, in the form of lower access, higher cost and lower quality. 
• Then, patients will demand “change” and will seek out quality care from the smaller number of then-available physicians still able and willing to provide that care…whether in an institutional setting, in private managed care practice, or in private fee-for-service practice. 
• And there will be many more such patients, older, sicker, more informed and motivated.
• Meanwhile, there will be several years of hard times for physicians, totally unaccustomed to such a situation – unless they are old enough to remember the Great Depression. 
• During this painful period, physicians must survive as best they can, thinking and working “out of the box”.  Two points: a) nothing helps better than an enhanced income stream, however legally obtained; b) the first rule of Service is…Survival.
• Within five years there will be plenty of needy and appreciative patients…too many, in fact.  But that is a problem that we as physicians have been trained to solve.