The scale of the Do-it-Yourself (DIY) Health Reform movement is dramatically bigger than I realized when writing about how that movement could affect the Talent Wars taking place in the tech community. So much so that I'm convinced we're on the cusp of the third, and by far the biggest, major wave of Health IT. The first wave was the introduction of mainframe/minicomputer based departmental solutions. The second wave was characterized by client-server systems and a greater degree of integration across the healthcare enterprise, though still limited between healthcare organizations. Neither of the first two waves dramatically altered the landscape for healthcare. In contrast, the third wave will fundamentally alter the competitive landscape. Healthcare's hyperinflation has ignited the DIY Health Reformers to declare what amounts to a Declaration of Insurance Independence . While the reformers recognize insurance plays a vital role for managing high risk events (house fire, car accident, cancer), the fee-for-service model underlying insurance in day-to-day healthcare has created what translates into a 40% "insurance bureaucrat tax" that they want freedom from.