**1. Introduction**

The need for primary care to serve as the foundation of U. S. health care has been recognized for years. Many efforts have been taken to make that happen through medical education and practice. However, despite considerable progress toward that goal, the U. S. still lacks such a foundation, as international studies of 11 advanced countries clearly show.

This chapter has three goals: (1) to bring historical perspective to the evolution and progress of primary care in this country, despite system obstacles; (2) to describe current attempts to rebuild primary care; and (3) to briefly consider the road ahead.
