entrants, less restrictive, and more responsive to changing health care delivery. Relentless pressure to control expenditures has caused private-sector payers for health care services to deny training costs, putting teaching institutions and GME at risk, and increasingly shifting the burden towards responsible governmental public payers like Medicare. For this and other reasons, the plan notes the desirability in principle and practice, of a general, non-Medicare or all-payer contribution to the funding and makes some suggestions on how to distribute such a contribution.