As medical costs escalate and the number of Americans without health insurance continues to rise the 2008 presidential candidates have responded by putting health care near the top of their agendas. Indeed many candidates have already laid out detailed programs to address the nation’s health care problems. As a result meaningful change in the system seems likely to occur once a new president takes office. As Mark V. Pauly Wharton professor of health care systems notes: ”I’m optimistic this time that we’ll get something.... There is actually a chance of doing more good than harm and I wouldn’t have said that in some other years.”