We shall explore the roots of the current system by studying 20th century American medicine and trends in this century which have both reinforced the negative but have provided a glimmer of hope for the future. Certain 21st century challenges such as the unmitigated cost of medical education, the haphazard and uncoordinated response to the pandemic which revealed serious gaps in care, and an underfunded and overwhelmed public health system, have provided the impetus for an employed physician workforce and potential unionization as well as better trained and funded public health departments.

I shall share my personal experience as a physician and physician executive. My expectation is class members will share their experiences with the health care system to provide areas for the group to explore together. Finally, we shall provide some hints where the system could change for the better in terms of rationality and equity despite forces which are reinforcing cost.