In discussing a book on disruptive innovations in a business class I am currently co-teaching, a medical student/MBA candidate said he believed our political system and vast medical complex, including Big Pharma, would preclude any meaningful disruptive innovations. I told the student, “You are describing incrementalism, which is basically making changes the slow way, by consensus and degrees.”

I contend that even with the entire “buzz” the Affordable Care Act (ACA) has created, it still represents only incremental moves to change the health care industry. I say this because it still depends heavily on private insurance companies. The main thing the ACA does is require people to have coverage and that insurance be sold through an exchange. Now, it is true the insurance sold through the exchange will be subsidized for person earning up to 400 percent of the poverty level. That is a big change. But, largely the actual delivery of health care as a result of the ACA remains pretty much the same. Sure, there is talk of an advisory panel that will eventually give advice to doctors, and there is some movement of money away from hospitals. However, it is pretty gradual.

Incremental models of reform do much to perpetuate the status quo. Whether it is cost, access or quality, these gradual changes will not yield significant gains to society. But, watch for future generations of change to the ACA — that is where the action will be.