I think it is fair to say that there have been two overriding needs of the health care system in the United States for the past couple of decades. One of them is to provide an adequate minimal level of care for all, especially for the underinsured and for those who could be faced by catastrophic health care costs. That need points to an expansion of health care expenditures and to the creation of new programs and strategies. The second need is that of finding a permanent and effective way of controlling the constant escalation of health care costs, and of the proportion of health care costs in our overall economy. That need points to restraint and limitations, not constant expansion.

We are left, then, with two apparently contradiaory needs, each pointing to a major problem, but each standing, it would seem, directly in the path of the other.