Increases in health care expenditures are threatening our society's ability to meet other vital priorities. As recently as ten years ago, 6% of the gross national product was spent in health care. The figure is now more than 10%. No one knows the exact limit society will tolerate, but an increasingly vocal and sizable segment of society is pressing for moderation in the rate of increase. Of particular note is the depth of concern and stringency of actions threatened by such disparate bodies as the federal government, the private health insurance industry, and the business community. Reduction of Medicare benefits, transfer of payment responsibility to beneficiaries, increased use of co-payments, mandatory second opinion programs, and the promotion of provider organizations judged likely to be cost-conscious (health maintenance organizations [HMOs] and preferred provider organizations) are all in the mill.1
See also p 1886.
In an effort to stimulate a broad