Corporatization and consolidation in health care -- Increasing privatization and lack of accountability -- Increasing technology -- Increasing specialization and sub-specialization -- Decline and fragmentation of primary care -- Soaring costs and unaffordability of care -- Decreased access and quality of care -- Changing ethics in medicine and health care -- Religion and medicine: a bad fit -- Growing gap between medicine and public health -- Marginalization and criminalization of mental illness -- Decline of physicians' professionalism and autonomy -- Medical education -- Rural practice -- Teaching and administration -- Writing, editing, and medical publishing -- Return to rural practice -- The post-practice years: changing political perspectives and advocacy for reform -- Today's health care: so far short of the needs -- What can we learn from this evolution of health care? -- Directions toward health care reform -- Whither the future?