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November 3, 1999

Managed Care, Charity Care, and the Common Good

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(17):1619-1621. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103

To the Editor: Dr Fletcher1 suggests that doctors, government, and health maintenance organizations should collaborate more in the areas of "teaching, research, and community service." He refers to these areas as "important aspects of health care as a whole."

But as important as attending to these areas is, any success achieved will be short-lived unless serious attention is paid to reform of the US malpractice system. Because the current malpractice system frightens physicians, it compels them to practice defensively, thereby raising the cost of health care by billions of dollars a year. It is difficult to say exactly how expensive defensive medicine is.

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