This issue of the journal connects health care payment with quality from a variety of points of view from many professionals who have been active in the field for decades. The authors have worked in state and local government-academia, the public and private sectors. Graham Atkinson starts the issue with overall recommendations. There is an accompanying commentary from Michael Schwartz and Joe Restuccia. I then provide specific reflections on my work which, though done a very different way, covers many of the same topics that Graham touches. Bob Berenson, in both a personal and an academic manner, provides a welcome response. Lastly, if we are to make any progress on connecting payment with quality we need to imagine a more effective way of tying population health management with primary care. Neil Smithline in his article provides us with a picture of the opportunities and challenges. Each of the articles in this issue highlights in its own manner the key issues confronting the American health care system. Unless we address the salient issues identified we will, simply put, never reform the American health care system and get to universal coverage.

The other more general articles in this issue address many ambulatory care issues of concern to the journal both in the United States and abroad. Martin addresses community asthma education integration into primary care concretely commenting on some of the issues brought up by Neil Smithline and others in the first part of this issue. Corallo et al address connections between mental health and primary care. Gagliardi and colleagues with their article on automated telephone outreach touch on one of the main issues in reaching individuals who need to be engaged in population health management. Lee and coworkers address important community health worker controversies. Janatic identifies the same challenges we all face-the small number of individuals who consume most resources-but from an Iranian perspective. In her Letter to the Editor, Lasser briefly addresses a common primary care-population health management-one cannot provide effective primary care to someone without electricity in the home and Lasser briefly addresses home shut-offs.

-Norbert I. Goldfield, MD

Editor