When I started practicing medicine more than thirty years ago, I believed the system was imperfect but noble. We worked hard, we cared deeply, and I thought that if we just kept doing our best, things would gradually improve. I trusted that technology, new policies, and better organization would eventually bring us closer to the ideals of medicine. Some of those changes helped. Many did not.

If I am honest, there were times when I became part of the problem. I measured my own worth in RVUs, not outcomes. I learned the business language of health care and repeated it back because it seemed easier than challenging it. I accepted the trade-offs as the cost of working in a modern system. I told myself I was just doing my job, even when I knew the structure was failing the kids and families I served.

Now, after three decades in practice, I cannot deny it. My generation of physicians has not succeeded in making health care better. We have seen margins grow while mission has withered. We have watched hospitals consolidate, clinics close, and executives thrive, while children still wheeze in emergency departments at three in the morning when they should have been cared for in a clinic that never existed in their neighborhood. We have let the left blame the system, and the right blame personal choice, while the patients in front of us remain caught in between.

A mirror in moral ambition

That is why Rutger Bregman’s new book, Moral Ambition, struck me so deeply. It held up a mirror to what I, and many of us, have lost along the way.

Bregman describes how idealism and ambition are often split apart. Idealists cling to purity but rarely accomplish much. Ambitious people climb ladders and seek prestige but lose sight of higher purpose. The combination that matters (the one that truly changes lives) is moral ambition: the stubborn marriage of drive and conscience.

Reading his words, I realized how often I have drifted toward one side or the other. I have had seasons of pure idealism, where I railed against inequities but left little real change in my wake. I have had seasons of pure ambition, where I chased RVUs, sat in meetings, and accepted the game as it was. What I have not always had is the courage to marry the two: to be ambitious not for myself or my institution, but for patients and justice.

The left, the right, and the limits of blame

Bregman’s framework also explains why our political conversations about health care feel so stuck. On the left, the reflex is to blame the system. Every poor outcome is chalked up to oppression or greed. Every disparity is proof that capitalism itself is broken. The outrage can be righteous, but the solutions often stop at slogans or policy proposals that never reach the bedside. Purity is protected, but results are scarce.

On the right, the reflex is to blame personal choice. People should eat better, exercise more, work harder, take responsibility. Poverty and illness are seen as failures of willpower. This can sound practical, but it ignores how deeply circumstance and structure shape the choices available in the first place.

Both sides contain fragments of truth. Systems matter. Choices matter. But neither frame actually heals. Neither gets a mother timely prenatal care. Neither prevents a child from missing school because of an untreated asthma flare. Neither lowers the rate of infant mortality in poor neighborhoods.

What is missing is ambition; the determination to go beyond blame and actually solve problems. Ambition that crosses divides. Ambition that is willing to persuade unlikely allies, to build coalitions, to compromise strategically without giving up morally. As Bregman reminds us with the story of abolitionists, the movement gained traction not just by preaching morality but by reframing arguments in ways that could persuade a wider audience.

How my perspective changed

I can trace this same lesson through my own career. As a young doctor, I believed that caring deeply and working hard would be enough. I thought the system, imperfect as it was, would rise to meet me. That was idealism, but without ambition.

As I moved into leadership roles, I allowed myself to be swept up in the culture of measurement. I hit RVU targets, I tracked margins, I played the business language back to administrators. I told myself that was what leaders did. That was ambition, but stripped of morality.

Now, with the benefit of perspective, I can see clearly that neither approach has been enough. My generation has overseen more consolidation, more corporatization, and more disconnection from the communities we were supposed to serve. We were not powerless, but we were not ambitious in the right ways. We did not pair our ideals with the courage to drive change.

What moral ambition could mean today

So what would it look like to reclaim moral ambition in health care?

In the clinic, it would mean refusing to reduce our work to throughput and productivity. It would mean noticing which families keep missing appointments and asking why, rather than moving on to the next patient. A “no-show” is often a signal of need, not neglect. The missed visit may represent the patient who needs us most.

In the community, it would mean bringing care to where people actually live. Schools, churches, and community centers are already trusted places. Families should not have to navigate a maze of phone trees and bus lines to be seen. If we are serious about ambition, we will carry health care to the front doors of those who need it most.

In leadership, it would mean changing the way we define success. CEOs and boards should not be rewarded only for growing operating margins. They should be held accountable for outcomes in the neighborhoods with the worst health. Incentives should follow equity, not expansion.

In policy, it would mean advocating for programs like Medicaid and CHIP not only as moral imperatives but as smart economics. Preventing hospitalizations, keeping children healthy enough to learn, and supporting mothers through safe pregnancies are not partisan issues. They are common sense investments in the future.

And in innovation, it would mean using technology to close gaps, not just to bill codes. Artificial intelligence could flag the children who never made it to their well visit, or the family that keeps cycling through urgent care. If we are ambitious in the right ways, we can use new tools to strengthen relationships rather than replace them.

Learning from history

This idea of moral ambition is not new to medicine. It is what drove public health leaders to eradicate smallpox, insisting that every community be reached. It is what inspired local citizens to build children’s hospitals brick by brick, long before health care became an industry. It is what led to the creation of Medicaid, when enough Americans across the political spectrum agreed that leaving the poor without care was intolerable.

Those moments were not about left or right. They were not about prestige or purity. They were about the combination of conscience and drive—the same combination we are now being asked to rediscover.

A challenge to this generation

If my generation has not managed to move the needle, maybe the next one will. But it will not happen by accident. It will not happen through blame. It will only happen if we rediscover moral ambition.

The temptation will always be there. Some will cling to being “noble losers,” proud of their purity but unable to move the needle. Others will settle into being careerists, collecting titles and bonuses while the mission slips away. Both postures are comfortable. Neither changes lives.

The hard path is the one that combines idealism with ambition. The one that risks failure by aiming at problems that matter. The one that says: I will not just diagnose what is wrong. I will take responsibility for making it better.

Closing

After thirty years in medicine, I am convinced that the greatest loss in American health care is not simply financial, political, or cultural. It is the loss of moral ambition. We had it once. We let it slip away. Now we need to reclaim it. That begins with humility. I have to admit that my own generation has not succeeded. We have been more adept at navigating systems than at changing them. We have been quicker to protect our own positions than to take risks for our patients. But humility alone will not heal patients. Ambition alone will not heal systems. The only way forward is both. That is the challenge Bregman sets before us in Moral Ambition. And it is the challenge we must set before ourselves if we want health care in this country to be worthy of the people it was meant to serve.

Mick Connors is a pediatric emergency physician.