Bob, There are other paths to social change besides policy change and practice change. As R Buckminister Fuller says, ““You never change things by fighting against the existing reality. To change something, build a new model that makes the old model obsolete.” That requires building a new system, not changing the old system. Furthermore, all your 10 steps related to lobbyists and laws and budgets, sure I’ve been working for free on this for about 20 hours a week for years and I’m on top if it. But guess who has 9 paid lobbyists who work on fat salaries and work 40 hours a week and just counter-vent everything I do? The provider lobby. And these public health foundations are still funding the PROVIDERS to do the advocacy work. How you supposed to do these 10 steps WITH NO MONEY???? And where is the funding for advocacy? It’s going to the providers.