An informal “think tank” founded by Paul Elwood, MD, President of Interstudy, in the early 1970s. Elwood convenes a small group of persons interested in the problems they perceive in the health care system at his home in Jackson Hole, Wyoming, and leads informal discussions on possible solutions to the problems. Their commitment is to “shaping sensible, market-based health care reform in the U.S.” A total of nearly 90 individuals have participated in the discussions, now held about every three months, although any given meeting is limited to about twenty invited persons. The three constant members are Elwood, Alain Enthoven, Stanford University health economist, and Lynn Etheredge, Washington, DC, based consultant. The group gained national attention with the 1991 release of a “white paper” entitled “The 21st Century American Health System: The Jackson Hole Group Proposals for Health Care Reform Through Managed Competition.”