Almost all countries of the free world have serious problems with their public healthcare systems. Mainly two problems make them unaffordable: On one side it is the demographic development of an aging society with all the aspects of the chronic diseases, on the other side it is an unbelievable progress in medical skills which also increases the cost. On November 20th, DER – Dialog – Europe – Russia and Prof. Wolfgang Aulitzky, president of the Austrian American Foundation, held a very tense international round table dealing with this topic at Schloss Arenberg in Salzburg, home of the AAF. Medical Doctors, economists and politicians from Russia and different EU-countries compared and analyzed the existing public health systems, discussed the problems of accessibility and funding as well as the benefits of prevention and finally took a close look on the training of MDs in the different systems. Examples of best practice and attempts for fundamental reforms stood in the center of the discussions – which, as all the participants pointed out, could only be a beginning and should be carried on.