Americans have once again demonstrated when it comes to health reform, they are most comfortable with incremental, not comprehensive, policy changes.

With an increasingly distrustful public, a real-dollar price tag of over $2 trillion, policies that fail to address out-of-control cost escalation and a federal debt that is projected to grow from $12.3 to $21 trillion over the next decade (before new health entitlement spending is even added), comprehensive health reform is dead.

The turning point was January 19 when Republican state Sen. Scott Brown won the Massachusetts seat held by Sen. Ted Kennedy in the traditionally deep blue state, campaigning that he would be “the 41st senator to defeat ObamaCare.” His election was followed the next week by the president’s State of the Union message, which emphasized jobs, and did not even mention health reform until 33 minutes into the speech. The signature issue of his first year in office was relegated to a low priority. He blamed a lack of understanding on the part of the public. But most observers, and the public, more appropriately blame inadequate and potentially destructive policy.

Congress will respond by considering only modest, targeted health initiatives over the next year. This could include items such as short-term “patching” of projected physician payment cuts to maintain overall flat funding (with a relative increase in primary care reimbursement), limited expansion of the Medicaid populations, insurance reform to address pre-existing illness and anti-trust provisions, continued cuts to Medicare Advantage plans, and a host of tiny demonstration projects including bundled payments, medical home, and preventive care/wellness. Reimbursement pressures will accelerate across the board as the Administration turns its attention to controlling entitlement spending, focusing specifically on Medicare and Medicaid.

As a doctor, and one who deeply believes that having insurance makes a big difference in overall health, I am disappointed that the country has lost an opportunity to address in a meaningful way the issues of access and cost. Let’s all stay on the issue of health reform, but let’s focus on maximizing value to the patient. Patient-centered, knowledge-based, provider friendly, and consumer-driven delivery of health care within a carefully crafted federal and state framework of regulations that ensure equity and access can and should be done.

Americans have sent a powerful message to Washington in rejecting the president’s approach of too much centralized control of medical decision making, but let’s help our elected representatives craft a more market-based and patient-centered approach that yes can achieve better access for all.