The people involved in paying for and providing health care were quite busy while talking heads drew our attention to the (melo)drama of the 2012 General Election. Employers, the backbone purchasers of 49% of all health coverage, are moving on in search of more workable, sustainable models for providing coverage. Providers are right there with them, wheeling and dealing for a piece of the action.

Walmart – the nation’s largest single purchaser of health coverage – made deals with six providers for bundled payments. Boeing just kick-started an exclusive cardiovascular care deal with the Cleveland Clinic whereby any of its 83,000 employees, retirees or dependents will be flown to the Clinic for care, compensation for which was negotiated using bundled payments. Other employers are continuing to shift from defined benefit plans to defined contribution, echoing the retirement benefit shift of the 1980s and 1990s.

These actions should send a message to those still inclined to fight health care reform in general and Obamacare in particular: change is inevitable. More to the point, the worst way for it to happen in an already complex system context would be for it to occur piecemeal, resulting in more segments of access, quality and cost. Fragmentation is the last thing health care needs and specialization is one thing it already has in overabundance. So far, neither of those qualities have served the overall performance of the system terribly well in the long run leading us to the $1.3 trillion question we face today.