In military terms – the entire front has been breached, and has broken. It is regrettable; it is trueDie Untergang.
One of the best metaphors for healthcare in 2014. can be found in looking at “Downfall” (Der Untergang) where Hitler, masterfully acted by Bruno Ganz, met with his top staff as the Red Army swept across Germany.
For the first time in the war, they realized there was nothing to plan next – because there was nothing left that they COULD do. Command was lost – all there was left was for the wave of war to break like a natural force across Berlin.
I hear, “we are fighting a market whose planning horizon has eroded to about 6 months. Until we get that sine wave to stabilize, we’re going to have to stay in front of innovation,”
and “are the small guys really closing because of the “big box” healthcare systems…or constant pounding of government regulations…?”
Those are questions for the historians. Today, we are a city besieged, and it does not matter whether the strongest attack comes from the north-west or south-west, if we can stop neither. Things that we cannot influence, happen.
The wave will blow through us by 2015 like hail through corn, and we can make decisions again then, based upon what is left standing. Will it look like East Berlin, or West? I am not an optimist or a pessimist. I am a realist. I am sorry, but I have to call them like I see them.
There is never anything despicable about hope. Please go on, look to what we might be able to do! But we cannot stop the rain.

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