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A Black Swan has struck health care reform. In May 2007 I wrote:

But for the moment, I don’t want to get into the specifics of contending views here, as much as I want to talk to how we go about our thinking in health care. One interesting way to see the current debate is through a notion now making the literary and intellectual rounds — the Black Swan. At the risk of being faddish, I think it’s worth exploring for a minute.

A Black Swan is a rare event we never see coming, has extreme impact, and after it occurs, we rationalize that it was ever so predictable. Nassim Nicholas Taleb, author of popular book in question, argues that history and societies do not proceed along some linear line, but “go from fracture to fracture, with a few vibrations in between.” It is the singular, the unseen, the accidental and the unpredicted — and our “chronic underestimation” of these possibilities — that account for the FUTURE straying from any course we initially envisioned.

It doesn’t take too much of a financial genius to figure out that the wall street meltdown will have at least two dramatic effects on health care reform: 1) coverage for the uninsured will be nearly impossible in the short run (a decade?); and 2) enormous pressure will build to constrain and shift costs to health insurers and providers further eroding the economic viability of the private health care sector. And while the Presidential candidates during the recent debate avoided the serious question of what has to wait, the adults in the room did not need to have things spelled out.

As I have said before, any of the official “futures” for health care reform at are now DOA. And we don’t need to pay any futurist to tell us how that story will end since the plot has yet to be revealed. Stay tuned.