Public opinion polls consistently reveal that U.S. society wants three basic characteristics in its healthcare system: (1) convenient access to skilled professionals and quality services for everyone, including primary care and specialty personnel and services especially for the very seriously ill; (2) personal affordability at both levels of service; and (3) happy health professionals. Meeting these three goals simultaneously has proved to be quite challenging. The goal of universal access to basic and specialty services pulls against the goal of affordability. Health professionals caught in the middle of this struggle find that their satisfaction with work conditions suffers as a result. If truth is the first casualty of war, worker and consumer happiness appears to be the first casualty of substantive healthcare reform in the United States.