Today's excellent post The Intensifying Collapse of the Health Care System, Why It's Different This Time, and What We Need to Think About Along the Way by health care market analyst Brian Klepper and family physician David C. Kibbe (of the Health Care Policy and Marketplace Review blog) paints a scary portrait of the lack of genuine cooperation amongst the various healthcare stakeholders.

Or as I see it, each player at the healthcare reform table is saying "we'll focus on what's good for us ... and to hell with the rest of you!" The biggest losers, of course, being patients (people like you and me).

The article is long, alarmed and thoughtful. It's peppered with observations like:

We can already see evidence that the dysfunction of our traditional health system is accelerating.

... It is useful to remember that the health care industry's different stakeholders are adversaries. While they clearly share a common understanding that a wholesale meltdown is possible, there is little real motivation for collaboration and no unity.

... But each silo within the industry has been separately focused on growing its own slice of the health care pie. In every niche, there are courteous conceits - access, appropriateness, efficiency and value - reserved for the good manners of public relations. But these are meaningful in practice only if they do not conflict with the professional's or the firm's economic performance.

... Short of an enterprise-wide catastrophe that sinks all ships, fundamental differences in goals will also make any real collaboration and compromise among the power players difficult.

... We see circumstantial evidence that the health care industry is under unprecedented siege in the marketplace, the fruit of longstanding business practices that, as John Sinibaldi so eloquently pointed out last week, have consistently favored health care vendors over patients and purchasers.

... The two fastest growing segments of the health care financial sector are individual credit scoring and collections, specifically aimed at capturing available dollars for the system. In this economy, aggressive collections practices will drive many more patients into bankruptcy, intensifying consumer dissatisfaction and further fueling the engines of change.

... A majority of the American people are very unhappy with the system, and nearly every sector of the health care industry is under increasing and unsustainable stress. American health care's storm clouds are gathering. It's very ugly right now, and getting worse.

... The good news is that, as the system becomes becomes increasingly unstable, the opportunity also increases for a full scale overhaul of health care, as well as for the development of both policy- and market-based solutions that build on experience and that can have lasting utility. If our leaders are unwise and susceptible to special interest influence, it could also go the other way. But times like this are our best shot, because the problems are so glaring and the solutions that are in the common interest so straightforward.

I have long maintained that the only event that will precipitate real change in our infected near-gangrenous compound fracture of a healthcare system is one that exposes the nearest and dearest of our Senators and Congress folks to the deep sepsis. Then we'll have a big outcry!

And if there isn't enough evidence to prove that we're in a mess, I have just gotten off the phone with yet one more burned-out frustrated primary care physician seeking help in finding a new non-clinical career. She told me "she can no longer go on, and has to get out of medicine". Her biggest concern - what others will think of her!

She has my sympathy.