By Geoff Colvin, senior editor-at-large

Steward Health Care System's Ralph de la Torre

FORTUNE -- What's the future of American health care? Dr. Ralph de la Torre, CEO of Steward Health Care System, may represent the answer. Steward, owned by the private equity firm Cerberus Capital Management, is a growing Massachusetts-based group of community hospitals, and industry analysts say de la Torre is one of the most dynamic and influential executives in the business. He's consolidating hospitals, finding efficiencies, investing big in infotech, and creating a new model that he says won't change much regardless of how Obamacare's future plays out. De la Torre, 46, is the son of Cuban immigrants and became the chief of cardiac surgery at Harvard's Beth Israel Deaconess Medical Center at age 38, then gave up practicing medicine to become a CEO. He talked recently with Fortune's Geoff Colvin about why health care reform isn't about public health, how health care is like the auto industry, why costs must continue to rise, and much else. Edited excerpts:

Q: Assuming Obamacare is fully implemented, what are the most important ways in which it will affect our lives?

A: The guiding principles were to do two things. One is to expand coverage. The other is to change the fundamental way health care is structured. Right now we're a society that believes you lead life the way you want to, and then at the end when the wheels start falling off the cart, you pound it with resources and get interventions from medical specialists to keep you alive longer and healthier. It's a very back-ended -- and because of that a very expensive -- way of getting health care.

If we're going to increase access and engage people to get their health care in a different way, we have to get young people involved. We have to get people who for all practical purposes really don't need health care insurance. We're going to be suffering from the fact that we never paid for wellness or prevention in the past, and the baby boomers are now coming of age. We can't pay for it all without putting a tax on the young -- call it what you want to call it, it's the truth. But by getting the young involved in health care through an individual mandate, it also lets you begin wellness and prevention.

We need to understand as Americans that it's going to cost us more for the next five, six, seven years or more. There's no way around it. We've increased access, and we're shifting our care to include more prevention and more wellness, but we can't turn away the people who weren't part of that to begin with, so we're going to be double-paying for a while. In the long run we need to do that. We need to start that shift now.

Medical costs in the U.S. are growing faster than the economy. That trend can't continue. It's got to stop, so how is it going to stop?

It stops by attacking the culture, getting people to engage more in wellness and prevention, and also by challenging providers and caregivers to treat based not on hope but on reality.

A lot of us physicians went into medicine because we loved the art aspect of it. There wasn't a lot of real hard-core science when many of today's doctors went into medicine. It was your intuition, your abilities, the gestalt of what was going on. But something happened in medicine along the way. It started becoming a real science, and a lot of studies have come out that guide what we do and how we do it. We as a society need to understand that science has to guide our practice of medicine. Not everyone with a headache needs a CAT scan; not everybody with a sprained ankle needs an MRI.

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