There are two trends in our industry. One trend towards, one trend away. Towards patient involvement and empowerment, particularly in the collection of biometric data critical for accurate diagnosis. And away from the encounter-based model, where patients and providers encounter each other only in discreet events – office visits, with little to link the events and little to no contact or outreach between events, and a sea of amnesia tenuously holding it all together.

The current system fails everyone. It fails providers by over-burdening them with administrative costs, particularly the cost of being reimbursed for services, and it takes them away from the very reason they got into medicine in the first place – to improve peoples' lives by improving their health. In doing so it turns the average practice into a highly-specialized real estate venture whose primary purpose is bill collections.

It fails payers by demanding that the only path to profitability is via a media barrage of hostile publicity. It fails them with an ever-changing landscape of procedures and treatments, tried and untried (experimental), effective and placebo, while expecting them to determine the popular efficacy of those procedures with the consequences of getting it wrong being either bankruptcy or public scorn (pick one).

And it fails patients in ways too many to count but almost always with dividends of suffering, terror, and the ever-looming threat of economic ruin. And that's for the lucky ones.

In my travels throughout this country, interviewing clinics, observing hospital procedures, looking at the books of medical equipment manufacturers, the insurance industry, and hearing hundreds of patient stories – including those of my own, my father's, my wife's, my late wife's, and my friends there are two themes.

Whether provider, whether patient, whether payer: everyone is miserable under the current system. And everyone is terrified that it might change. The fear of the unknown is an even stronger deterrent than the hatred of the known. No one understands or likes the way things are but the perception is that at least the bird is in the hand. And there are no bushes to be seen, anywhere.

Misery and the fear of change. Instead of Asclepius' rod, we have the Caduceus: two snakes winding their way through every experience in struggle, not harmony.

The inevitable future is manifest. A future of continuity of care, of patient empowerment, and the transition of the physician from piecework mechanic to retained therapist. The old business models will fail, though they will fail in an industry most reluctant to change. Many will chose to resist the inevitable and hold instead to another future, a future that is already dead.

Twenty years hence they will find themselves in the same place that those companies who clung to steam locomotives when diesels were inevitable found themselves. They will find themselves in the same place that the companies who could not make transistors lest they cannibalize their existing vacuum-tube business. The supermarkets who would not offer organics even when their customers begged for them.

Our industry, or at least its existing firms, can choose the same path – to cash out on the way down and then dissolve in a tepid cauldron of inertia spiced with irrelevancy.

But that is neither necessary or inevitable.