In recent years, health policy analysts and decision makers have increased their concern over the plight of uninsured patients, uncompensated care, and the changing complexion of the nation's health care system. 1-4 This period, however, has seen far less attention focused on the fragile, nationwide network of great public hospitals that already provides those health services—the institutions that serve in effect as America's national health insurance by default. While the Congress has sought repeatedly in the last several years to require extra attention in the Medicare and Medicaid programs to the need of such hospitals, it is only in the last several months that the Reagan Administration has finally been forced to provide such relief (1986 Consolidated Omnibus Budget Reconciliation Act [COBRA] Public Law 99-272). (See Gage L, Newman H: Lawsuits, legislation mean federal relief for ailing hospitals. Legal Times 1987;9:14-16.) The series of four articles on public hospitals that is