Part I The Uninsured, Health Care Costs, and Public Programs. The U. S. Health Care System: On a Road to Nowhere? / The U. S. Health Care System: On a Road to Nowhere? / Jonathan Oberlander. Wanted: A Clearly Articulated Social Ethic for American Health Care / Uwe E. Reinhardt. From Bismarck to Medicare? A Brief History of Medical Care Payment in America / Donald L. Madison. The Sad History of Health Care Cost Containment as Told in One Chart / Drew E. Altman and Larry Levitt. The Unsurprising Surprise of Renewed Health Care Cost Inflation / Henry J. Aaron. The Not-So-Sad History of Medicare Cost Containment as Told in One Chart / Thomas Bodenheimer. Medicaid and Medicare: The Unanticipated Politics of Public Insurance Programs / Lawrence D. Brown and Michael S. Sparer -- Part II Managed Care, Markets, and Rationing. Bedside Manna / Deborah Stone. Must Good HMOS Go Bad? The Commercialization of Prepaid Group Health Care / Robert Kuttner. Defending My Life / Geov Parrish. Business vs. Medical Ethics: Conflicting Standards for Managed Care / Wendy K. Mariner. The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation / George J. Annas. Ethics of Queuing for Coronary Artery Bypass Grafting in Canada / Jafna L. Cox. Rationing in Practice: The Case of In Vitro Fertilization / Sharon Redmayne and Rudolf Klein -- Part III International Perspectives and Emerging Issues. Reforming the Health Care System: The Universal Dilemma / Uwe E. Reinhardt. Health Care in Four Nations / Thomas Bodenheimer and Kevin Grumbach. Keeping Quality on the Policy Agenda / Elizabeth A. McGlynn and Robert H. Brook. What's Ahead for Health Insurance in the United States? / Victor R. Fuchs. Luxury Primary Care? Market Innovation or Threat to Access? / Troyen A. Brennan. Correspondence: Response to Luxury Primary Care. Limiting Health Care for the Old / Daniel Callahan. Scapegoating the Aged: Intergenerational Equity and Age-Based Rationing / Robert H. Binstock.