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May 19, 1989

Family Practice

JAMA. 1989;261(19):2845-2846. doi:10.1001/jama.1989.03420190121036

Events of the past 10 years have left many physicians reeling from professional shock and wondering how the practice of medicine as they once knew it could have changed so dramatically. Increasing competition, the advent of prospective payment and managed care, the evolving role of peer review, the malpractice crisis, and other changes have introduced new challenges to medicine, challenges that have tested many physicians' enthusiasm for their chosen profession. Even so, a more far-reaching change looms on the horizon, a change that will reflect a growing public-policy mandate and bring to full circle the philosophical course charted a quarter-century ago through Medicare.

Despite having what some people consider the best health care system in the world, many Americans find themselves on the outside looking in. Over 40 million people are disenfranchised from health care to one extent or another by not having adequate health insurance. Many of these people