FEW WOULD dispute that our health care system is deeply troubled. Thirty-nine million Americans are completely uninsured and millions more have inadequate coverage. After a brief lull, health care costs have resumed their exuberant growth; health maintenance organizations (HMOs) have fallen to the basement of public esteem and have failed to contain costs; commercial pressures threaten medicine's best traditions; and healing has become a spectator sport, with physicians and patients performing before a growing audience of bureaucrats and reviewers. Opinion on solutions is more divided.