The chaotic state of today's health care is the result of an explosion of effective medical technologies. Rising costs will continue to trouble U.S. health care in the coming decades, but new molecular strategies may eventually contain costs. As life expectancy is dramatically extended by molecular medicine, a growing population of the aged will bring new problems. In the next fifty years genetic intervention will shift the focus of medicine in the United States from repairing the ravages of disease to preventing the onset of disease. Understanding the role of genes in human health, says Dr. William B. Schwartz, is the driving force that will change the direction of medical care, and the age-old dream of life without disease may come close to realization by the middle of the next century. Medical care in 2050 will be vastly more effective, Schwartz maintains, and it may also be less expensive than the resource-intensive procedures such as coronary bypass surgery that medicine relies on