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Robert H. Fletcher, MD, MSc

JAMA. 1999;281:1127-1128.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Just 6 years ago, the United States began to acknowledge on a broad scale that there were systemic problems with its health care system—problems that simple adjustments, called "Band-Aids" at the time, would not solve.¹ After flirting with a plan proposed by the Clinton Administration to create a crosscutting federal role in the organization and financing of health care, the nation embraced competition in the marketplace as the way to manage growing problems with cost and quality.

Regardless of whether the marketplace will provide a lasting solution to cost and quality problems, it is not designed to deal with some important aspects of health care as a whole. Specifically, teaching, research, and community service (care of disadvantaged and vulnerable people and of communities themselves) are essential to a sound, compassionate health care system. Not only are these social responsibilities, they are investments in the health . . . [Full Text of this Article]

Author Affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass.

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