. . . the U.S. health care system is flawed principally because we have never asked what its goals are. So long as that fundamental moral question remains unanswered, no amount of political or economic tinkering will fix the system's problems. If we carefully examine the present workings of our system, we would have to conclude that its goals are two: maintain the prerogatives of physicians and the well-being of the private insurance industry. Such goals hardly represent an exercise of moral choice, and . . . are morally indefensible.