The United States is experiencing a decline of the middle class. What does this trend imply for the future of organizations such as

(a) the U.S. Public Health Service, which operates many inner-city health. clinics for the economically disadvan- taged, and

(b) the Scripps Clinic, a large multispecialty group practice in Southern California? For years, the Scripps Clinic was seen as an exclusive medical provider known not only for treatment but also for its research.