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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.

A new synthesis in search of synthesizing agentsComment on “A new synthesis”