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practitioners and their patients. And, while I will sometimes
refer to the health care practitioner as a "physician" for
reasons of brevity, I hope you will understand that the
suggestions I make will apply equally to whomever your
health caregiver might be.

I've also done my best to define my terms as I go

regarding sexual identities and behaviors, but the fast-
changing nature of cultural perceptions of sexuality has
made this difficult. Chapter Eleven of this book includes a
glossary for further clarification.

On the health care system. For you to understand

many of the ideas in this book, you need a little bit of
background on the realities of today's health care system.
Medicine has become very large, very complex, and very
much a business.

Many people today belong to health care maintenance

organizations (HMOs), which provide care for a lower
monthly premium than other forms of health coverage.
HMOs operate by paying each physician a monthly fee for
each patient who chooses him as a primary care physician.
Physicians join an independent practice association (IPA).
The HMO makes a deal with the IPA, often without
consulting either the patients or the physicians who have
to live with the results. As a general rule, you pay for
what you get.

The HMO's goal is to enroll patients who will pay their

fees while utilizing as few of their resources as possible.
The physicians' goal is to enroll so many healthy patients
who rarely if ever need to see a doctor that they can
make enough money to give their sick patients all the
time they need.