Both the National Health Planning and Resources Development Act of 1974 and the Emergency Medical Services Systems Act of 1973, as amended, indicate that HEW and congressional thinking is moving toward the view that systematic mechanisms for providing health care services by our pluralistic industry is a reasonable policy direction. Dr. Kenneth M. Endicott, former administrator, Health Resources Administration, in describing the HSA program said, “This new system of planning for the delivery of health services does not attempt to alter the basic structure of the health care industry, but retains the essentially pluralistic, free enterprise nature of the health delivery system. It may place some needed restraints on that system, but it leaves the decision making power in the hands of the citizens, providers and officials at the local and state levels.” Clearly, the HSA and EMS programs focus on the highly scientific and technological world of modern medicine and the associated hospital industry, with the belief that controlled, systematically planned, and delivered services by the primarily private health care industry will improve the health status of the American public. Frequently, it is possible to agree upon goals but disagree on the means for achieving them. PL 93-641, in both law and HEW programmatic implementation, evidences federal determination to improve the efficiency of the health care industry by reducing costly waste, eliminating excess hospital capacity, and prohibiting duplicative services. Thereafter, reallocation of resources to programs that improve health status can be achieved without higher federal spending. The HEW Bureau of Health Planning and Resources Development is relying primarily on the combination of rule and regulation authority and control of local health systems agencies to require industry compliance. In contrast, the EMS program proposes that the rate of death and disability can be reduced by systematic medical control over the care and management of emergency patients within the current medical and hospital capabilities. In theory, this improvement in patient care for critical emergencies, less than 5% of all emergencies, will also improve patient care for all emergency patients. Systematic planning and operation of EMS is viewed as a challenge that requires strong state involvement and local governmental financing and participation. The mechanism to influence industry compliance to this service delivery model is a clear and strong appeal to medical leadership from the belief in the medical profession's historical capacity to shape the health care industry.