Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
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.
Renz-Polster H. Managed Care: Success or Failure. JAMA. 2001;286(13):1576-1577. doi:10.1001/jama.286.13.1573