It seems clear though that this massive spending has not improved the health of Americans. It is clear too that as the population ages, there must me major changes in America's health care delivery system. Is it feasible for the American government to guarantee health care delivery for the nation's poor and elderly? What financial measures will be needed to realize an efficient health care system? How will advances in medical technology affect health care cost and delivery? how will the physician's role evolve over the next twenty years?