Luigi Naldini, a pioneer of gene therapy, and Giuseppe Remuzzi, one of the most authoritative voices on the future of Italy’s National Health Service, bring together two complementary visions on the present and future of care. The dialogue begins with the extraordinary opportunities offered by advanced therapies—revolutionary approaches that are transforming medicine and opening new horizons. Yet these innovations also raise crucial questions: how can we guarantee access to treatments that are extremely costly and complex? From here, the conversation moves to the sustainability of healthcare, intersecting with the structural challenges facing public health systems: inequality, underfunding, and systemic crises. At its core, this is a debate about how science, equity, and policy can—and must—work together to ensure a future in which “care,” even that born at the cutting edge of research, remains a universal right.