Five years ago, I returned to the University of Michigan to pursue a doctoral degree in health economics and policy. Although I had been a practicing physician for almost 20 years, I lacked a basic understanding of the American health care system. I was uncertain how Medicare and Medicaid worked. Terms like single-payer system, all-payer system, HMO, PPO, PSRO, and HCFA were unclear in my mind. I also labored under the naivete of the uninformed in that I felt there must be easier and better ways of providing for the health of the nation.