“Well, you know we've only been a tertiary care hospital for the last 30 to 40 years; maybe we should consider what we need to be for the future.” There must be a vision of the future in the United States to make health care change easier rather than a reflex “digging in of heels” to resist the loss of something we have had.

Finally, the energy and action orientation of Americans is incredibly unique. Many other countries struggling to make changes in their health care systems know what they want to achieve, but they do not have the managerial or organizational skills or resources required to make those changes. We do, if we have the will and the vision. That is one of our gifts as a people. We must use this gift to begin and sustain a process of change that can ensure the best health care delivery system and the best health for all of our citizens.

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