Since the increased efforts to improve medical care for Americans were initiated 15 years ago, it is generally believed they had little impact on the problems addressed. Review of national data suggests otherwise. American medical care and health status are getting better. We have improved the availability of physician services and largely eliminated the gap between visits made by rich and poor, or white and black citizens. We have greatly expanded the number of health professionals who provide medical care. Better organized programs to provide care to groups with special health problems have reduced both mortality and morbidity. Age-adjusted death rates, infant and maternal mortality, and death rates from coronary artery disease have fallen. While there remains an important agenda for the future, there seems room for cautious optimism about the abilities of American society to make forward progress.