The importance of organizational form in American medicine has been the subject of much debate. But the character of the debate-the nonprofit form versus its competitors-has been sufficiently confused that much of the controversy should be reconsidered. That debate has been both ideological (commercialism and profit versus service and professionalism) and practical (which form is more efficient)? The challenge of public policy is to adapt public rules to the central realities of American medicine, not the shibboleths of shrill discourse. In the case of medicine, factors other than the form of legal ownership-among them, the nature of the service provided, the developmental stage of the service, the role of physicians in providing the service, and the nature of government regulation-are more important in fashioning those appropriate responses.

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