**4. Current approaches to rebuild primary care**

It has long been apparent that system reform will be required in the U. S. before primary care can grow and thrive at its foundation. Our non-system has been taken over by corporate stakeholders dancing to the tune of Wall Street investors, not the needs of patients, families and taxpayers. Before we can move back to a traditional service ethic in health care based on the public interest, major reforms will be needed. As the distinguished medical historian, Rosemary Stevens, observed 20 years ago:

*The most important impediment to a clear-cut role for family practice has been the lack of a formal administrative structure for primary care practice on a nationwide basis in the United States [28].*
