Traces the historical reasons for the access and cost problems plaguing the U.S. health care system. Explains why both problems are likely to get worse. Analyzes in clear nontechnical terms the advantages and disadvantages of different reform alternatives. Presents a proposal for health care system reform that recognizes the cultural and political realities that any realistic U.S. health care reform must tackle: a strong cultural aversion to centralized administration and high public sector costs, an entrenched private health insurance industry, and an established tradition of employer-based health insurance.