Since coming back from D.C. Monday night, I’ve been almost paralyzed to do this blog, not with “writer’s block” but with “writer’s flood.” There are so many issues, ideas, concerns, and hopes swirling around in my head that I can’t seem to get a coherent thought out. (Don’t go for the obvious joke there!) But I just got off a phone interview with a reporter who asked me to compare the Clinton era reform to the Obama era reform efforts. I said to him, “Somehow, it feels different, even likely to happen this time around.” And as I think on this more, I realize that I am optimistic. In the end, we’re going to make some important progress on healthcare reform this time. But why do I feel this way?1) *President Obama as Negotiator-In-Chief*****: I believe that the President is leading but listening, deciding but not dominating. He has been consistent and clear that healthcare reform must happen now, and he has given guidance on his high-level strategy (pay for quality over quantity, incentivize wellness and coordinated care, insure everyone). Now we are hearing complaints of some who say he has not been clear or detailed enough, but I think he learned from President Clinton’s approach to be more cautious and reticent to step on the toes of Congress. He is trying to spark real dialogue and thinking about these hard, complex, culture-changing issues…with deadlines in place to make sure something really happens. I think he has to be Negotiator in Chief, and is well on his way to doing that. 2) *Positive Effects of a Down Economy*****: Someone once said to me, “Governments respond better to threats than opportunities.” (If anyone can find this original quote, I would be grateful). Which is to say: perhaps we, as a nation, had not hurt enough or were not under enough imminent threat when Clinton tried to do healthcare reform to find the political will to move it through. Back then, our crisis was theoretical, in the future, and could be pushed off the agenda. But our current recession is real pain for a lot of people. And compared to the economic collapse that many experts say is looming from the healthcare cost/capacity crisis, our current downturn could be a mere dress rehearsal for a much worse economic drama. We are now under threat, so can no longer defer the hard decisions. 3) *Boomer Consumers and the Y2K + 10 problem*****: While we were all paying attention to the Y2K problem back in 2000, there was a far more pressing social change that got ignored as we rushed to replace our aging computers. Demographers tell us that for the first time in human history, there were more “older people” than “younger people” at that time. And now we have what I call the “Y2K + 10” problem, as the first Baby Boomers in the United States reach retirement eligibility in 2010. This age wave is not an American phenomena, but a global one. And I think every tick of the clock has the Boomer generation, who have transformed almost every other institution in our country, on the verge of transforming healthcare as well. They will create and demand new approaches to self-care, consumer-oriented services, support for themselves as family caregivers for their parents, and alternative options to long term care. Don’t underestimate the power of the boomer consumer to drive real reform…and a lot of them are about to have a lot of time on their hands. They will not retire gently into that good night…they will drive “Boomerstock” type culture changes to be reckoned with. 4) *Parties Approaching Reform in Good Faith*****: Having met with dozens of associations, companies, and government offices over the past weeks, I can tell you that no sector engaged in the healthcare debate seems to be acting completely selfishly. It’s as if everyone—hospital groups, physician groups, insurers, pharma, employers, government, patient groups, family caregiver associations, and many more—has realized that we’re all going to have to be prepared to give something up, we’re all going to have to change some behaviors, and we’re going to hurt the country—and ourselves—if we simply “dig in” to protect our turf. I’m not so naïve to believe that each “interest group” is prepared to just roll over…but I do believe there is a sensibility this time that it’s in our collective interests to be open to the idea of giving up some of our specific and special interests. 5) *Reform Has Become a U.S. Competitiveness Issue*****: Over the past 10 years as I have worked on personal health, I have found most consumers unaware that the U.S. healthcare system, while a leader in both costs and innovation, is not the most effective compared to other countries by many, many measures. And there were other myths and misunderstandings—for example, that long term care was paid for by Medicare. This time around, the dialogue and data about the U.S. seems more balanced, pervasive, and sobering. While it was former Intel Chairman Craig Barrett who I first heard beating this drum nationally, I now I hear a lot of people talking about how hard it will be for the U.S. to compete in a global economy if our healthcare costs are so outrageous and so under-performing compared to other countries. I hear a lot of people also saying that health reform could help generate new healthcare technologies and services that the U.S. could “export” to other countries who are also dealing with the age wave, if we get ahead of the game. We are the nation who produced revolutions in the computing and communications industries that made this a global economy…we better keep investing in education and innovation to make sure we benefit from our own inventions. Some of my friends and colleagues wrote privately to me over the past weeks, trying to boost my spirits after I was feeling so frustrated from some of my D.C. meetings. When Congressional visit after visit yields so little immediate action on moving the personal health agenda forward, it can be a downer. It is hard to maintain hope when you can get the meetings, have important people get so engaged and excited about the ideas of personal health, only to have them tell you that “it’s just not on the agenda.” But I have to remember that government, by definition and design, is rarely bold and innovative. It is slow to change…resistant to fads and trends…has checks and balances in place…to treat our nation and culture with utmost care. I even understand that some amount of partisan tension (though certainly not the extreme partisan rancor I have witnessed of late!) is natural, normal, and even necessary to balance our ideas. In that light, I realize there is still reason to be hopeful. While government may not be moving as fast and furiously as I would hope, the facts of the matter are: healthcare reform is a priority, debate is happening, bills are being ironed, and the age wave clock is ticking. There is an attitude of urgency, without panic, and collective sacrifice and responsibility, without compromising every interest, that leaves me feeling like healthcare reform is inexorable, inevitable, and—even when hard and scary—good.