Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.

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.

When we, doctors, ask patients what their priorities are if time is short, what we do is we use what is available to us - whether it's geriatric care or palliative care or hospice care - to make sure they're living the kind of life that they want to live.

In the end, people don't view their life as merely the average of all its moments-which, after all, is mostly nothing much plus some sleep. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life maybe empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves.

We have medicalized aging, and that experiment is failing us.

Developing a skill is painful, though. It is difficult. And that's part of the satisfaction. You will only find meaning in what you struggle with. What you struggle to get good at next may not seem the exact right thing for you at first. With time and effort, however, you will discover new possibilities in yourself-an ability to solve problems, for instance, or to communicate, or to create beauty.

You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they dont have the physical skills but because they dont have the moral skills - to practise and admit failure.