ABSTRACT
A half century ago a national Committee on the Costs of Medical Care concluded that "many persons do not receive service which is adequate either in quantity or quality, and the costs of service are inequably distributed. The result is a tremendous amount of preventable physical pain and mental anguish, needless deaths, economic inefficiency, and social waste." 1 Although much progress has been made in the past 50 years through the advent of private health insurance and public programs, problems of access remain and are compounded by the perceived need to respond to rapidly rising health care costs and expenditures. As that earlier committee observed, "The United States has the economic resources, the organizing ability, and the technical experience to solve this problem." 2 The question now is whether the country's formidable health care resources can be applied in a way that is fair to all—be they patient, provider, or taxpayer.
