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February 27, 2002

Poverty and Responsibility for Health Care—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(8):988-989. doi:10.1001/jama.287.8.983

In Reply: My intent was not to repackage old ideas about the uninsured but to draw attention to the increasingly systemitized system of barriers they face,1 not to blame private physicians but to impugn a nonsystem that financially punishes those who care for the poor, not to engender guilt but to fuel collective purpose.

Although it was the focus of my essay, the problem of uninsurance has vanished from Dr Knoll's letter. He replaces it with the doctrine of individual responsibility: the central problem with the US health system is "the patients themselves." The logic, apparently, is this: if the uninsured practiced better health habits they would not need so much medical care, thus making irrelevant their lack of insurance. Never mind that much illness is not preventable.

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