The U.S. government, through financing, regulations, and laws, is reshaping the organizational structures underlying medical practice, medical research, and medical education. To formulate laws, regulations, and financing mechanisms in a way that will improve the overall health of the American people, administrative and management changes are needed in both the nonfederal and federal health sectors. The nation needs to fix responsibility for health education, for determining the numbers and distribution of health professionals, and for long-range policies regarding support of medical research and education. The country may need a new type of health professional, trained in universities for public service. The federal health apparatus should be restructured, creating a Department of Health that is staffed by career health professionals who are insulated from politics. This new career system should encourage movement from the private and academic sectors into and out of governmental positions.