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''Big one'' coming for health care. (Next!).

Article Excerpt
I live on the coast of northern California, among redwoods and vineyards at the edge of the crashing sea. If you moved here, you would have many different experiences, but there is one thing I could guarantee: sooner or later, you will feel the earth move.

Today's health care--what we think of as "business as usual"--is a kind of California. It exists at the grinding margins of vast tectonic plates with names like "technology," "demographics" and "epidemiology." Sooner or later, things will shift and change on a far larger scale and in a far more sudden time frame than we expect.

We are vulnerable. We are muddling through. At some point, muddling will not be enough.

What if?

Consider a few examples:

* How much of your institution's bottom line is derived from cardiovascular care? What would happen to your finances if an inexpensive drug appeared that could reliably prevent atherosclerosis and stabilize and shrink atherosclerotic plaque? Such a drug exists and is in the final stages of human testing. Other drugs also carry promise in the fight against heart disease.

* How much of your bottom line is based on caring for cancer patients? What would happen to your institution if cancer became a pharmaceutically controllable chronic disease? A number of drugs now in human testing show this promise.

* How much of your bottom line depends on complex...