a new synthesis in search of synthesizing agents; comment on “a new synthesis”

in a recent editorial in this journal pierre-gerlier forest foretells a coming revolution in health policy based on the synthesis of four conceptual innovations and one technological breakthrough. as much as i agree with the intellectual story told in this editorial i present a more skeptical view of the effect of paradigm shifts on healthcare systems on the ground. i argue that ideas triumph when times are ripe and times are ripe in health policy when payers and providers can find a compromise between the need to value what providers do and their professional autonomy. i also argue that autonomy is a product of the market: patients value autonomy and prefer doctors to insurers.