After a few years of success in controlling the costs of health care, the United States once again faces the challenge of what, if anything, to do about skyrocketing health care expenditures. Dealing with this challenge, which dominated the health policy agenda from the late 1960s until the mid-1990s, will be extremely difficult under any circumstances. It may prove impossible unless the factors that prevent poor and uninsured persons from obtaining medical care are addressed simultaneously.

David Blumenthal, M.D.

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