We now have 30 percent, for example, of Medicare patients who are seeing doctors who are rewarded for doing this kind of work, like high blood pressure control. So, the Affordable Care Act has pushed this direction down the road.

What about regular professionals, who just want to do what they do as well as they can?

Over time I learned that there are two very different satisfactions that you can have in your life. One is the satisfaction of becoming skilled at something. It almost doesn't matter what the terrain is. There is a deep, soul-feeding resonance in mastery itself, whether in teaching, writing a complicated software program, coaching a baseball team, or marshalling a group of people to start a new business.

There are times when you have sharp elbows, and people are trying to muscle you out of certain meetings - because then people could leak to the press that you had a role in certain decisions. I, at twenty-six, was very impatient and didn't know how to keep my powder dry. I was running a team of seventy-five people when I had never been a boss. I was the worst boss ever.

Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work - whether in healthcare, education, climate change, making a pathway out of poverty - is the great task of our generation as a whole.

If I became just a brain in a jar - as long as I can communicate back and forth with people, that would be okay with me.

The Affordable Care Act also offered protections that allow for preexisting conditions, as people know, that you're provided coverage and you can maintain steady coverage. And that's an important part of being able to stay in care and do better over the long run.