We also need to become more engaged and vocal in addressing one of the large underlying problems responsible for the plight of the poor: the lack of universal health insurance. Gruen and colleagues 2 recently outlined the professional responsibility of all physicians to address factors that influence the health of the public. Hospitals and physicians alike are responding to the lack of a financing mechanism and offering services based on financial return and not on what may be best for an individual patient or the community at large. Half of all physicians, but 75% of pediatricians, support legislation to establish national health insurance. 3 Disturbingly, residents or fellows and more recent medical school graduates were not more likely to support such legislation in this recent survey as compared with their older counterparts. Somehow, changes that are occurring to students and residents during training are lessening support for this national answer to the problem of health care for the poor and many working families. The silence from physicians and hospitals regarding universal access is deafening.Finally, we need to realize that these are moral and ethical issues for which there are right and wrong an-swers, and the conscious decisions we make do affect others, especially the most vulnerable in our society.