Ron Paul and subsidiarity

Jonathan Kay on the U.S. healthcare debate that's slightly disorienting to Canadians. He says Ron Paul has:

a single theme: that the health needs of needy Americans can be met at the local level — through charity hospitals, voluntary collectives, and religious organizations

Paul saw it work in the 1960's. Kay says it wouldn't now; we've come to expect:

teams of specialists and capital-intensive high-tech diagnostic equipment that are far beyond the means of the sort of neighborhood health clinics and charities that Ron Paul sentimentalizes.  

So -- is subsidiarity incompatible with the best possible care for everyone? That isn't a rhetorical question. I'm really wondering about it.