A single-payer system would not be simpler. Our experience with Medicare tells us that government cannot do it simply.

We are entering what George Lundberg has called the Golden Age of Medicine, and it is a message that we must continue to send as we go through the fundamental reorganization of the way in which health care is financed and delivered in this country. George quotes Dizzy Dean, who, when the bases were loaded and nobody was out, used to say, “The ducks is on the pond.” He believes the bases are loaded with resources and opportunities. If we manage our resources properly, we will be successful. Will we be able to achieve a goal of adequate numbers of well-trained and competent primary care practitioners? I am as optimistic as that other great American philosopher, Yogi Berra, who said, “They said it couldn't be done, but sometimes it don't always work out.”

REFERENCES

1. Lee, P.R. 1992. Address at the National Primary Care Conference, Washington, DC, March 29.

2. Institute of Medicine. 1978. A Manpower Policy for Primary Health Care. Washington, DC: National Academy of Sciences.

3. Council on Graduate Medical Education. Third Report. Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century. October 1992. Washington, DC: Council on Graduate Medical Education.

4. Petersdorf, R.G. 1992. Report to the Federated Council for Internal Medicine. October 29. Washington, DC: Federated Council for Internal Medicine.

5. Altus, P., et al. 1992. Declining interest in internal medicine. Archives of Internal Medicine 152:1374–1375.

6. Colwill, J.M. 1992. Where have all the primary care applicants gone? New England Journal of Medicine 326:387–393.

7. Astin, A.W. 1991. The American freshman: 25 year trend. Los Angeles: University of California.

8. Association of American Medical Colleges. 1992. Task Force on the Generalist Physician. October 8. Washington, DC: Association of American Medical Colleges.

9. Bowman, C.L. 1993. Inadequate training. The Internist: Health Policy in Practice, January:28.

DISCUSSION

IGLEHART: Now it is the audience's turn to ask the panelists questions and to comment on the presentations.

SHINE: Dr. Boufford, you described the “fundholding” approach as being used in terms of the general practitioners in Britain. You said they buy hospital services. Does that mean that the primary care provider must become part of a group? Can an individual practice individually? How would they buy hospital services? The flip side of that is a question for Dr. Nelson, namely, if you are a terrific patient advocate and the pri-



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