Naming the elephant in the room.

Dr. Keale is senior research scholar, Center for Clinical Bioethics at Georgetown University Medical Center, Washington, DC. T he market! The market is the elephant. For some, the marketplace is the solution to what ails the health system. For others, the market is the source of many, if not most, of health care's ills. Everyone should therefore come to the tableto discuss the elephant—to get a better sense of "the virtues and limits of markets. Critical reflection on the role of the market in the health care sector has important ramifications for health care professionals, health care organizations, health policy, and patients and communities. Thus, we should begin by identifying: