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To the Editor.—It is encouraging to see the concern and energy put forth by the medical community, including the Archives, regarding the very serious problem of access to health care in the United States. The 16 proposals in the "Health Access America" initiative of the American Medical Association and the general press given this issue earlier this year focus on many useful and long overdue reforms. However, I think it is a mistake not to request reform from the recipients of medical care as well as the providers. Our medical system is in effect a supply and demand system: currently, the supply (ie, health care providers and medical resources) is insufficient to meet the demands of the American society. Current dialogue has oriented on improving the interaction between the supply and demand (expand financing and benefits, reduce costs, change liability laws) and on increasing the supply (develop medical breakthroughs,