An entrepreneurial government would preserve the decentralized nature of our system, with many different health care institution, but would push for less hierarchy, so more of the routine medical care could be provided by less expensive nurse practitioners, midwives, physicians' assistants, and nurses. It would encourage enterprising behavior by health care institutions, making them survive in a competitive (although carefully structured) marketplace. And it would structure that marketplace to meet social needs. Simply by requiring that insurers and prepaid plans take all comers, for example, it could end the current practice of competing for the business of low-risk patients and dumping the rest on the public sector.