THE HEALTH system reform debate is over how to organize, deliver, and finance personal health care services. At $1 trillion, the enormity of the health care sector warrants a healthy debate about its structure and the respective roles of the public and private sectors. Erosion of middle-class health insurance coverage and an insecure economic and employment future have mobilized a broad constituency for insurance market reforms.1,2 Distributive justice issues raise concern for the 40 million Americans without health benefits. Lost, however, among discussions of health security, universal coverage, and competitive markets is the unstated principal mission that any health system must serve to improve the health of the entire population. Legislators know that increasing public interest in health reform is attributable to the emergence of health insurance coverage as a middle-class issue.2,3 An increasing proportion of the voting public has become part
See also pp 1276 and 1297.