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The predicament of twenty-first-century medicine is emblematic of other trends in American society. How we shape the values and directions of the health care delivery enterprise will determine and reveal the kind of society we create in the coming years. Because the trends that have brought us to this point are entrenched and ongoing—especially the dominance of private industry in health care services, the priority given to technology use regardless of cost, and the lack of equity in the distribution of medical care—they continue to derail the practice of medicine and the entire health care delivery enterprise as a social good.

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