Of the many elemental management objectives of American health system reform, 3 have always stood out: control of cost, promotion of quality, and access for all to basic medical care. Many of us hoped to achieve all 3 of these major objectives in a comprehensive, organized, and timely way while preserving necessary patient and physician autonomy, promoting prevention, and emphasizing primary care, among other factors.1
Alas, such was not to be. What has happened? Cost control has been achieved in many sectors in large part because of the managed care revolution. Access has worsened. And quality is now under attack.2,3
The JAMA Editorial Board and senior staff and the editors of the Archives Journals have completed their annual Delphi process to identify and rank the most important topics for our journals to address in the upcoming year. Near the top was quality of care. Since quality cuts across