My read from the title forced me to review the article. To my surprise, the
focus on better distributions of income, education, etc. as driving health
care cost, quality, and outcomes was refreshing.

I would also agree that the social organization as in the Quebec lower and
middle income groups, was critical.

The only areas where I would significantly differ are political terms.
While capitalism seems to have a consistently poor connotation for
Rosenthal, I would substitute "unaware top 30% leadership of the nation" in
its place. Regardless of various systems, there are certain types that rise
to leadership positions, usually stemming from advantages in birth and
parents.

There is nothing wrong in nations that practice the best forms of
capitalism, however unaware forms of capitalism that concentrate wealth,
income, education, and services are among the most destructive. Capitalism
based on a strong foundation of all children with a great first 8 years of
life, is difficult to match. There are few stimulants to better education
and full development of human potential.

Sadly when children in nations feel that they have little ability to alter
their future life course, they are not likely to invest in constructive
activity and are more likely to invest in destructive areas and divisions
are likely to worsen, as well as the inefficiency of government and the
inability of government to deal appropriately with the problems. Of course
this may be true in all systems.

Robert C. Bowman, M.D.
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