Combine a new Democratic Administration and Congress which sees it as a priority with a business establishment desperate to offload employee health care costs and something is going to pass.
What does pass will have a big role for health IT, with industry leaders already advising the President-elect on incentives for adoption. (One such adviser is Glen Tullman, CEO of AllScripts, above. He's a Bucknell man. Go Bison.)
Despite the skepticism from both me and ZDNet readers on its money-saving potential, health IT is seen as the silver bullet for reform.
It is most likely this will take the form of mandating Electronic Health Record (EHR combines Electronic Medical Record (EMR) files) adoption, probably delivered through clouds rather than local networks.
There are risks in this approach. It's a one-size-fits-all solution, imposed from the top-down, with little consideration given various office work-styles. But it can be rolled-out quickly.
How much of what's behind the curtain will be open source is yet to be seen. AllScripts, which is pushing the ASP solution, off-loaded its Misys software into an Open Health Tools project this month. The stuff may be good but who will be its rabbi?
A rabbi, in this case, is not the leader of your synogogue but a trusted elder who sponsors your rise within a bureaucracy. It's more than a mentor, it's the person who gives you your chance.
I have speculated here that Robert Kolodner could be the rabbi open source needs to get through the government's health IT door. But his rabbis are Republicans -- will that taint him?
My guess is that by the end of this year hard decisions will have been made, but results will be thin on the ground. The year will be a fight, which is fun for journalists but not so much for doctors and patients.
It's doctors and patients whom reform is supposed to be about.