Real by 2028
By 2028 — the fiftieth anniversary of the Alma-Ata Declaration — the full model mapped in this framework will be operating at scale: a cooperative delivering the complete clinical and delivery system described here.
2038 is the horizon beyond: a decade to refine the scaled model, describe it, replicate it, and carry what works into communities elsewhere in the world.
Everything below is what we will need to do together to get there.
The Vision
Build a primary care system that is globally accessible, community-powered, and economically sustainable — one that treats quality of life as the foundation of medicine.
Globally accessible
- Grounded in the Declaration of Alma-Ata (1978): health as a fundamental human right, primary care as the mechanism for achieving it
- Scientifically sound and socially acceptable — the Declaration's bar for legitimate care is accessible if we decide to do the work and trust in our ability to care
- No proprietary content — the barrier to entry is doing the work, learning to trust the model as a foundation
- One model, built to travel — adapted to a place, to people, to community
Community-powered
- Member-owned cooperatives, rooted in the communities they serve
- A federated backbone that lets local clinics share real infrastructure — technology, insurance, training — building the resources around the space between patients and their care team
- Governance that belongs to the community
Economically sustainable
- Better delivery. Better care. Better outcomes. Plus, a cost structure that can sustain it.
- Primary care purchased directly, major-medical coverage built to support it
- Insurance restored to its proper place — the layer behind catastrophic events, while direct care carries the everyday relationship
Quality of life as the foundation
- Capacity measured against a person's own potential
- Full functional recovery as the target endpoint: resolution carried all the way through, past the point where relief alone would have stopped
- Health care exists only in the relationship between a patient and their care team — everything else is infrastructure in service of that, or it's overhead pretending to be care
The Challenge
Take what is here, build from it, make it real in your community, and share it with the world.
- The proof is already in motion — more than twenty years of study, more than fifteen years of practice, a working clinic, and a model now being built to scale.
- The knowledge already exists — across medicine, therapy, prevention, public health, and lived clinical experience. The opportunity is to bring it together and deliver it consistently.
- The method is here — a way to organize that knowledge into care, connect the pieces, and hold the full arc from stabilization through recovery.
- The roadmap is written — six phases that turn the model into something communities can build, test, strengthen, and replicate.
- You can begin where you are — use what is here, gather the people around you, and start building the version your community needs.