None of us would have the jobs we currently occupy without some ability to focus on details. Running a company, developing IT systems, managing a hospital, seeing patients and evaluating their concerns--all require the ability to dig deep and identify root causes and effective solutions. But maybe that focus on the trees blinds us to changes in the forest, to use a well-worn aphorism. With that broader perspective in mind, I'd like to suggest four reasons for optimism as we continue to move through this wholesale experiment in tinkering with the healthcare system of a large and diverse nation.