In the same week that President Barack Obama decreed health reform must happen by year's end, emeritus faculty Victor Fuchs declared health reform will happen in the next few months, but Americans should be wary of predictions for what these reforms might be.

"What we can talk about are possibilities," Fuchs said to the 200 guests at the FRESH-Thinking Project on Health Care Reform Capstone Conference, an event of cross-sector healthcare leaders co-sponsored by Stanford Health Policy, the Stanford Institute on Economic Policy Research (SIEPR) and Stanford's Center for Advanced Study in the Behavioral Sciences.

Fuchs' keynote speech drew together the day's discussions on what health reform might look like from a myriad of experts -- doctors, economists, public health advocates, insurers and academics. Days earlier many of the speakers had flanked President Obama's closest advisers at an executive meeting of health care experts meant to push forward the presidential health care agenda.

Fuchs' sentiment that health reform will happen in the next few months was echoed throughout the day, though with a notably tempered tone during the morning talks focused on the economics of sweeping reform.

Days earlier UC Berkeley School of Public Health Dean Stephen Shortell and fellow speaker Alan Garber, Stanford Health Policy Director, had attended Obama's meeting of health care insiders, and each offered ways to curb costs in a system that, Shortell said, "leaks value." Shortell described the need for more accountability in the delivery system.

In his talk, Garber explained  the money saving potential of a system in which decisions about the use of medical products and services (whether developed by pharmaceutical companies, other technology companies, doctors, patients, or health plans) are based on a thorough evaluation of the benefits and costs of both new and existing alternatives. His idea of "value conscious biomedical innovation" would also empower patients to make informed health care choices by providing the side effects, efficacy rates, and costs attached to each treatment option.

SIEPR director John Shoven, though, delivered the health care talk that reverberated most in ex-post conference discussion. Cost control and universal coverage are not necessarily in conflict, Shoven said, referencing a report he and Fuchs had co-authored for the FRESH-Thinking Project "Funding Health Care For All Americans: An Economic Perspective."

Shoven disavowed two ubiquitous health care myths.  He noted that a kind of shared responsibility which dichotomizes government and employers ignores the fact that individuals, whether as citizens or employees, pay for health care. He also argued against the oft-repeated statement that the middle class can escape higher health care prices. Advocating a dedicated tax to fund comprehensive health coverage, Shoven concluded with a need for budget discipline, saying "We should not separate the benefits from the costs."

Fuchs and Ezekiel Emanuel co-directed the FRESH-Thinking Project, a Blue Shield of California Foundation-sponsored initiative that for the past three years has convened experts in the field to weigh comprehensive health care reform proposals. This conference was the group's culminating activity and brought together the project's core members including Sharon Levine (Associate Director of The Permanente Medical Group of Northern California), Harold Luft (Director of Palo Alto Medical Foundation Research Institute, and also with the University of California at San Francisco), Garber, and Shortell, (Emanuel stepped down from his role in the project in early 2009 to join the Obama Administration).

In the conference's opening remarks, President and CEO of the Blue Shield of California Foundation Crystal Hayling said she wanted the day to draw upon the history of lively discussion in the FRESH-Thinking Project on Health Reform. "I hope that we will continue that spirit today," she said. "Disagree with one another."

Hayling's charge was answered in the panel the "Public and Reform." Sandra Shewry, President and CEO of the California Center for Connected Health, said that we "cannot underestimate the power of language" in shared responsibility. Her co-panelist Gil Ojeta, Director of the California Program on Access to Care, echoed her sentiment, saying shared responsibility is vital to vast health care reform.

The public panel on health care reform was part of an afternoon dedicated to major constituent groups required for buy-in for a vast overhaul in the system -- doctors and employers were featured in two separate discussions.

Like speakers before them, the panelists agreed that health reform will happen in this administration. The concern often repeated, though, is that reform will be too incremental given the political barriers to comprehensive change.

Founding WellPoint executive director and University of Southern California Professor Leonard Schaeffer highlighted the "time is now" theme of a Washington interested in bringing about change. Countered by this era of transformation, though, is that to date real health care change has been prevented by those very political players. The general sentiment among politicians, Schaeffer said, has been to express empathy and then do nothing.

Adding to the barrier is the public split in its willingness to pay for universal coverage -- a recent Harvard/Kaiser poll shows 49 percent of respondents are unwilling to pay higher taxes so more Americans could receive insurance (47 percent would pay more).

Schaefer and many other speakers agreed that what is most disconcerting about health care reform is that piecemeal change in the system is the most politically palatable. But it is also the riskiest, Schaeffer said, since the system is broken to the point that we need to "transform the underlying delivery system."

Schaeffer closed his talk by saying it is highly likely we will see health reform passed but the question, he said, is "will it help or cause more problems? And based on my years and years (in this area)... I have no idea."