Some people are endowed with certain special characteristic such as brightness and beauty. There is a dark side, however. Those who are not blessed with natural beauty, intelligence, wit or wisdom are considered to be much less endowed in comparison to those who possess their traits. For example, regardless of how hard we work and regardless of how may times we take the test, there are limits to the extent that we can improve our scores on the college entrance exam or whatever screening test one needs to take in order to advance to the next level of academic opportunity.
 Many of the bright and the beautiful recognize that their beauty and the brightness of the contented is not of their doing. Some insist, however, that even though bright and beautiful, they have had to work hard to win in a stiffly competitive environment. Others, however, recognize that even their ability and their enthusiasm to work hard in a tough environment is a gift of parental upbringing, or of God. Additionally those who recognize of their good fortune have developed a growing sense of intimate personal responsibility not for those who have not been so blessed but for the contented themselves.
 Such differences have an impact on our healthcare system. As Galbraith says, those who are contented are forced to feel that the disadvantaged poor are the architects of their own fate. They are poor because they want to be. The contented have to hold to such a view because to do so otherwise, is to suggest that the disadvantaged may be due to the nature of the system – the system that is designed and supported by the contented-which could lead to feelings of guilt. In our healthcare system, the contented are using the free-market concept as a refuge to protect their financial self-interest. They have designed a system which may exclude the disadvantaged from obtaining services.
 In the past, to the extent that the uninsured were helped, it was in part through the charity of physicians and hospitals. In these competitive market, however, we simply tend to disregard the disadvantaged especially the poor and the uninsured. If the market is not financially viable, it is logical to assume that we will not spend much time developing services for this market. As the free-market system leads buyers to continue to put the squeeze on health providers and their institutions, the disadvantaged will be placed at even greater risk. Rather than see the healthcare system as a victim of market forces, we should see it as a proactive agent for systematic reforms. we need some fundamental changes for our healthcare system.
What do we, as a society, have to do for the less endowed?
 First, the new strategy of healthcare system for the disadvantaged will require a sharp break with obsolete patterns and emphases from our current system. The accent must be on mobility and flexibility, on ambulatory rather than rigid institutional care. We need to put our services where the need is out where the people live. The person needing care must have access to the course of treatment he needs, wherever it may lead.
 Second, carrying out this new strategy will require a major commitment. The governmental and non-governmental health forces of the nation must decide that here is where the action is, where the priority should be placed. Health resources are limited. Inevitably there is competition among many worthwhile projects for the use of resources. The needs of the disadvantaged must be given primacy in this competition until the tragic gaps are closed. More efficient use of limited resources by balancing primary care and preventive medicine on an “equal playing field” is one of the keys to close the gaps. Another key to success is a reasonable use of cost-sharing arrangements.
 Third, The new strategy will require new patterns of training for healthcare manpower. In short, our professional schools must turn outward to the community, become involved with its needs, and prepare their graduates to serve the community. At the same time there must be a major effort, on a large scale, to develop and use the talents of those who live in poverty stricken areas to the fullest extent in helping to solve their own problems.
 Finally, we have to consider the environmental change. The urban poor live in surroundings where smog hangs heavy, where refuse collects in streets, where rats run, and where plumbing fails. Further, there is a second dimension to the challenge of building a healthy environment. The social climate of the poor, with its nose and congestion, its ugliness and hopelessness, its fear frustration, aggravates conditions which breed mental illness, narcotic abuse, alcoholism, homicide, and suicide. These are epidemic diseases that cry out for a full-scale effort, by the health partnership alone but by all the forces of society that can help facilitate a better life.
 I think this is the key. In the Government many agencies in many departments are engaged in this effort. This effort is only a beginning. It needs strong allies to reach into the streets and alleys and mountain hollows where the problems are, where the people live, where the action must take place. we need a true voluntary partnership across the nation.

Dept of Healthcare Management professor Suh Wan Sik