H e a l t h c a r e t h a t i s s t r u c t u r e d t o a c c o m m o -date the sensitivities and demands of human biology will look different from health care that is organized to meet the requirements of stockholders and quarterly profits. Structure implies function in the corporate environment as decidedly as it does in the natural world. A health plan constructed for financial profit measures success quarterly. A health plan created to accommodate the needs of human biology, on the other hand, adopts the perspective of a life span; its success is best expressed in health outcomes and quality of life. Members ought to be able to trust that their HMO is primarily focusing on their health. Yet advocates of nonprofit HMOs have not succeeded in calling attention to their differences from for-profit organizations. Most surveys indicate that people do not understand or care about the distinction. One reason is that the not-for profits have done little to translate the relationship of trust that they have established with their members into market advantage, preferring instead to maintain an ivory-tower existence and to refrain from arguing the merits of their status.Nevertheless, the achievements of managed care in improving the health status of communities can be traced directly to the not-for-

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