Hubris in Healthcare Reform?

I am concerned we may be about to enter another cycle in healthcare where the hubris of high managements ultimately brings down another healthcare system restructuring that, again, harms the interface (i.e. patients and their trusted physicians). Borrowing some thoughts from Peter Drucker, management guru, who elegantly identified this “blind” high level forced management as undesirable, and touted the requirement of MWA (management by walking around), I believe it's well known that if you don't ask those that do, you'll do what you shouldn't do. Having lived through several previous failed cycles in healthcare…

• Capitation in the 80’s

• Managed care in early 90’s.

• Physician Management Organizations and hospitals buying medical practices in late 90’s

…I have real concerns the healthcare reform initiatives (PCMH, ACO, bundled services, etc.) are at risk for failure for the same reasons these other cycles failed. Those making decisions are not getting appropriate input from the interface. I continue to be amazed at the gap between the visions of policy makers (and administrators at all levels) and the realities at the point of care.
I see a strong need for a trusted, respected true physician’s guild to advise those administering healthcare delivery. This needs to be an entity that can truly represent the interface between healthcare and the patient. Its membership needs to be inclusive of all the major medical professional organizations, but its leadership needs to be filled by true representatives from the interface.
What might provide the nidus for just such a guild?
It is a bit frustrating that I visit with enlightened physicians almost daily who want to promote patient-centered care, yet can identify that their organizations and heathcare reform initiatives do not yet adequately understand or address the real obstacles. Many of these organizations and initiatives are close, but not close enough. A guild to advise organizations that is led by individuals that do not have to answer to organizational bureaucracies could actually strengthen many of these organizations for the very reasons they have weakened.
Otherwise, what evidence is there that we are not just entering another cycle, and are about to do more harm than good?
For patients and their physicians, I really would rather see reform float than sink. At least we don't have to worry about the captains, as history confirms their ability to just jump over to the next passing ship.