Dino has always felt that medicine is both a calling and a business. Physicians always do better financially when they focus on the altruistic nature of the profession. However it is a business and would not have thrived if it was merely a pathway to sainthood. Neither an MBA nor a philanthropist can reconcile the two. It appears to be a unique industry in this respect.

Over the past couple of decades an overwhelming amount of data has emerged that the US health system suffers from inadequate primary care capacity and quality. Comparative studies of health systems appear to demonstrate that primary care is a the critical function that makes health systems efficient and the most important part of healthcare, if we were to think of  healthcare access as a social good.

On the other hand, it is the technological achievements of American medicine that captures the popular mind. It has been said that preventive care relies on curative care for its credibility. However in the US, curative care is heavily subsidized by Medicare as well as employer=based health insurance (which functions more as a discounted group purchasing mechanism than traditional insurance.) So the US health care system has become dangerously out-of-kilter enhancing access to highly curative technologically-based care without the personalizing and rationalizing effect of a good primary care relationship

A single payer government-run is not the solution, a conclusion that comes out of Dino’s experience in Canada. In Quebec, he witnessed healthcare become a political instrument used to punish areas of the province that did not share the political ideology of the ruling party. There are good examples of health systems that rely on private insurance with a federal mandate for universal coverage. PPACA (Obamacare) is a step in the right direction, although it is flawed at the outset. In 2014, it becomes apparent that it will be fixed, not repealed, for the sake of US economic competitiveness.

Meanwhile the future marches on, and the health system likely will continue to have roots in a private market insurance system with significant employer contribution, enhanced public input, and a relative re sizing of primary care and specialty functions. Maybe one day, we will have a sustainable and balanced healthcare system, in which basics and primary care are covered universally, but access to more expensive and cutting edge technology is distributed more rationally and cost-conssciously.