CHICAGO — It was raining, it was 7 a.m., and it was the last day of the American College of Healthcare Executives 2014 Congress.

For perhaps those reasons, attendance at one of the two final ACHE "Hot Topic" sessions kindly could be described as sparse. Maybe attendees were more attracted to the alternatives, which included both attending the other Hot Topic session with the upbeat sounding name "Leadership, Health and Happiness" or just sleeping in.

Whatever the reason for low attendance, the message delivered by speaker Nathan Kaufman deserved a wider audience. Kaufman, managing director of Kaufman Strategic Advisors LLC, put into words what I suspect a lot of people already kind of know but don't want to openly discuss. The nation can't spend any more than it is on health care, it probably should spend less and, as a result, hospitals and doctors are going to see their pay reduced while needing to improve quality.

Kaufman's presentation was sobering in its straightforward nature. In other sessions I attended this week, the talk was about change, revolution and transformation. As Kaufman asked, how many ways can you say you've got one foot on land and the other in a boat? How much discussion can there be of second curves?

That sort of talk sidesteps some likely realities that made up Kaufman's core message. "It's not going to be pretty the next six years," he said. "I'm a proponent of the ACA. We had to do something," Kaufman said. "But it's not enough."

He also doesn't see things righting themselves very quickly. "I think we're going to have a great health care system in 2025."

He's probably right about the transition, but his timing is very likely wrong. Calling the top or bottom of a market is extremely difficult. There's a good chance the pain could be shorter and the success will come sooner or vice versa. Nobody can know how long it will take.

Kaufman, given his line of work of offering hospitals assistance, might have overcooked his argument by overstressing the negatives. In one of his anecdotes describing an industry that went through a painful pullback — the housing market — he noted that economist Gary Shilling predicted the bust. It struck me that his "prediction" came six years before it actually happened.

So, I wouldn't run screaming for the exits, but when the industry does reach the inflection point Kaufman described, it will be painful for many. The sooner hospitals and physicians can prepare for that day the better.