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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 multi-specialty group practice in southern California? For years, the Scripps Clinic was seen as an exclusive medical provider known not only for treatment but for research.

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