It's not a tableaux we had dared imagine just a few short months ago. President Obama pledging health reform at the White House, with everyone from the American Hospital Association to the pharmaceutical industry at his side, promising to save American families, American businesses, and the American taxpayer trillions in health care dollars in the coming years.

It makes it awfully hard for the skeptics to keep claiming that change is not possible, that savings are illusory, that the best we can do is tinker around the edges and put up with more of the same. 

Once feared for their potential to derail health reform (which they've done before), key private sector players in health care came to Washington Monday delivering a promise to do their part to slow the growth of health care spending. In a letter delivered to Obama and in a follow up meeting at the White House, representatives from AdvaMed (devices), AHIP (insurers), the AHA (hospitals), the AMA (docs), PHRMA (drugs) and SEIU (labor), pledged a series of concrete initiatives to lower the annual health care spending growth rate by 1.5 percent—for a total savings of $2 trillion over ten years.

White House officials called this a game changer.

Obama himself recalled the "special interests" who had blocked past reform efforts, and, with representatives of some of those special interests now at his side, talked about the potential for sweeping repairs to a health care system that spends too much and covers too few. In his remarks today he noted:

This problem didn't just appear overnight. For decades, Washington has debated what to do about this. For decades, we've talked about reducing costs, improving care, and providing coverage to uninsured Americans. But all too often, efforts at reform have fallen victim to special interest lobbying aimed at keeping things the way they are; to political point-scoring that sees health care not as a moral issue or an economic issue, but as a wedge issue; and to a failure on all sides to come together on behalf of the American people.

And that's what makes today's meeting so remarkable—because it's a meeting that might not have been held just a few years ago. The groups who are here today represent different constituencies with different sets of interests. They've not always seen eye to eye with each other or with our government on what needs to be done to reform health care in this country. In fact, some of these groups were among the strongest critics of past plans for comprehensive reform.

But what's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years; that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait. It's a recognition that the fictional television couple, Harry and Louise, who became the iconic faces of those who opposed health care reform in the '90s, desperately need health care reform in 2009. And so does America.

The groups are still working out the details, but broadly their proposals are as follows:

• Systems reforms to promote administrative simplification, standardization, and transparency in service of more effective markets
• Reducing over-utilization and unnecessary variation by providing incentives for quality and efficiency
• Promoting care coordination with an emphasis on chronic disease and evidence-based care
• Reducing the cost of doing business through health information technology, regulatory reforms, workforce adjustments and changes in delivery models,  

The signers also emphasized the importance of prevention and wellness to reduce the prevalence of chronic disease. They stressed such changes outside the delivery of care could save billions in lower health care costs and called for a specific focus on obesity that matched the magnitude of problem.

The news has even the New York Times' Paul Krugman sounding optimistic:

The fact that the medical-industrial complex is trying to shape health care reform rather than block it is a tremendously good omen. It looks as if America may finally get what every other advanced country already has: a system that guarantees essential health care to all its citizens.

Krugman and others of course are skeptical of voluntary efforts.The so called "Voluntary Effort" of the health industry in the 1970s to control costs failed to generate sustained, long-term savings. But TNR's Jonathan Cohn makes a key point on the difference between then and now:

This time, the industry groups aren't promising to control costs as an alternative to reform. They're promising to control costs as part of reform. In fact, some of the efficiency steps they are proposing wouldn't even be possible without the sorts of changes now under discussion in Washington, because they require changes in legislation. 

Comprehensive legislation still won't be easy. We know that. But it got easier today. As a very cheerful Len Nichols, the director of New America's health policy program told us, "It's a very good day."