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March 11, 1998

Articulating a Social Ethic for Health Care

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor


Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

JAMA. 1998;279(10):745-746. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-10-jac80000

To the Editor.—I admire the zeal of Dr Reinhardt.1Not a physician, he has missed the intimate view of medical science, medical practice, yes, even of poverty, which is part of every physician's training.

Reinhardt views medical care in the ideological abstract. Couple his zealotry with his lack of actual medical care experience and his Commentary, it seems, becomes socialist propaganda. His "pointed question" becomes a loaded question complete with the ancient propagandistic use of children. Asserting the superiority of access to care in other nations ignores the quality of that care once accessed. Who is the patient's advocate? Who actually delivers quality scientific medical care? At a pragmatic patient level, who gets cured, helped, and comforted, or who becomes a unit to process as quickly and inexpensively as possible? Even though fomenting class distinctions is now fashionable, a large middle class is much less inclined to zealously do so. Many Americans value equality of opportunity rather than financial homogeneity. Reinhardt failed to mention the large middle class when discussing the rich and the plight of the poor. There is a curious implication in such positions. There are the rich, the poor, and those with power to protect the poor. The manipulation of dependence is left unsaid. Hidden is the quest for power and control.

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