In the year 2099, all physicians will be employees of 1 of 4 major health care corporations. These corporations, vertically and horizontally integrated comprehensive systems of care, will be publicly traded for-profit corporations that will compete for patients and contracts across the United States. All Americans will be enrolled through a government-financed, universal single plan of care, as employer-based health insurance will have disappeared 50 years earlier. Americans will be able to choose which health care system they wish to join during an annual "open season" and will be able to select their primary and specialty care physicians. These corporate plans will compete with each other for access and choice as well as quality with "report cards" being regularly produced by the various state agencies that are charged with assuring accountability of health care within their jurisdictions. Many of the services will be provided directly in the home or the workplace through a broad and interactive telemedicine capacity since virtually every American will be "online" for their health care and other purposes. The home personal computer will receive instantaneously the latest in the science and art of the practice of medicine. High-tech health centers, so-called hospitals in an earlier age, will provide the sophisticated gene therapy, organ transplantation, and biomedical engineering that will be available to all in need. Approximately 33% of the gross national product will be spent on health care. Americans will live to an average age of 105 years. It would not be unusual to find some individuals still living at age 130 to 140 years. Most Americans at this age will have had their organs replaced by either genetically programmed animal organs or harvested organs from special banks. However, the brain will be the only irreplaceable organ. Psychiatrists will be primarily involved in the interface of brain and behavior as they have been for 200 years.