Abstract
With many academic medical centers reeling from the combined financial pressures of managed care and the Balanced Budget Act of 1997, their advocates have descended on Washington seeking relief. They stand a reasonable chance of winning some relief from Medicare's largest reductions in expenditures for hospitals in the program's history, but it is almost certain to fall short of what they are seeking. Moreover, longer-term questions will continue to plague these institutions, because the federal government is divided over how and at what level it should support graduate medical education and care for indigent patients in a market-oriented health care . . .

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