The united states is experiencing a decline of the middle class. What does this trend imply for the future of organizations such as (a) the U.S. public Health Service which operates many inner-city health Clinics for the economically disadvantaged, and (b) the Scripps Clinic, a large multispecialty group practice in Southern multispecialty group practice in southern California? For years, the Scripps Clinic was seen as an exclusive medical provider known not only for treatment but also for its research.