There are two problematics of health care reform facing most Western industrialized countries: the conservative problematic involves considering the merits of private and public health care services, even to the extent of revisiting policies that create first and second class health care citizens. The progressive problematic requires rethinking ways to extend community based health care. These problematics represent the two prospective ideological axes for health care reform in the industrialized world over the next twenty years. The best way of describing these ideologies is conservative and progressive, not because they neatly fit with mainstream political models but because conservative health care reformers want to maintain current systems of health care power, be they public or private, and the progressive view is that only through change to both public and private health care is it possible to realize a new set of appropriate health care outcomes that are about improving quality of life and placing sick, disabled or debilitated individuals in charge of their own health care destinies.