It's all over now except for some final posturing, potential lawsuits and proud pockets of defiance. For those who waited until after the Supreme Court ruling, and then waited some more until after the presidential election, the day is at hand. The only thing standing between procrastinators and health care reform is the Mayan calendar doomsday scenario, which predicts that we will all go careening into outer space on New Year's Eve. Now, this is not a viable alternative.

So whether you are still on the dock, or in the boat, or on a burning platform, or stuck in the "gap" trying to jump curves, one level of uncertainty is over. The march to a value-based system is going forward.

As tempting as it may be for all of us health care players to focus on our individual predicaments, another party also has a very big stake in the future system, and it's increasingly clear that we won't be successful — or rewarded — without their approval.

John Q. Public is in a strange position. The election revealed a public somewhat polarized by reform. But it was a "for'em or agin'em" attitude along political lines, belief in the role of government, or who yelled the loudest on TV and got the juices flowing, by golly. No one asked: What specifically do you know about it and how does that affect your opinion?

Surveys showed a strong consumer awareness of reform, but not how it would affect them personally. Some like what they've seen so far, such as young adults being able to stay on their parents' plan and no lifetime limits on coverage. Oddly, these friendly features seldom were mentioned. The individual mandate drew the fire — that single element out of the entire ACA.

Who can blame them for not understanding? How long did it take you to absorb the core ingredients? And you had lots of help. That, coupled with the lengthy implementation timeline, makes it easy to say, "Just wake me when we're there."

Consumers don't get the big picture health care system. They see health care as local and personal. They probably like their doctor; maybe their hospital, based on the opinions of friends and relatives. They don't like the cost and hear scary stories about people ruined by medical bills and insurance companies. And they have a general feeling that "something" isn't quite right with the big picture. They listen to people they know, and they don't know any policy wonks, economists, officials or "experts." Are they about to know you?

At some point, we must explain to patients the delivery systems we are building in their communities, why we are building them and how they benefit. Doing this one at a time as they come through the door won't cut it. One bright spot: A broad consumer survey by Deloitte showed that they are open to new integrated systems of care rather than random physician offices and hospitals.

What about employees? We can't assume they understand the what and whys either, particularly if no one gives them a comprehensive explanation. Yet, these are the people patients are most likely to seek out for information.

But then again, who knows? Come Jan. 1, we may be floating through space. Wave as you go by. But in the meantime, let's stay well grounded. You can reach me at