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October 3, 2001

Managed Care: Success or Failure

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(13):1576-1577. doi:10.1001/jama.286.13.1573

To the Editor: The article on the end of managed care by Dr Robinson1 is thought provoking. Medical care in the United States has long had a difficult time reconciling a largely market-driven delivery system with a largely need-driven reality. What Robinson suggests for the US health care system, however, is a new paradigm altogether: a health care system that from its very outset caters to consumers instead of patients. There is a crucial difference between a patient and a consumer—many patients are not consumers because they lack purchasing power, and many consumers are not patients because they lack conditions calling for medical interventions. Consumerism may be the "right thing for US health care," but it poses an ethical dilemma for physicians and other health care workers, who still derive many of their motives, self-respect, and social justification from caring for the suffering patient.