Over 120 Aboriginal communities run their own health services - some have been doing so for 30 years. They struggle with difficult medical problems. They also try to deal with counselling, stolen generations issues, family relationships, violence, suicide prevention.

Part of me thinks that innovation, real innovation in health care delivery, needs to happen from the bottom to the top.

I have profoundly mixed feelings about the Affordable Care Act. What I love about it is its impulse. It attempts to deal with this intractable problem in American health care life, which is that a significant portion of the population does not have access to quality medical care.

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