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August 3, 1994

Improving Health Care for the Poor

Author Affiliations

Concordville, Pa

JAMA. 1994;272(5):353. doi:10.1001/jama.1994.03520050029016

To the Editor.  —In his article on health care for the poor, Dr Ginzberg1 begins with a clear account of the complex problems facing reformers. Unfortunately, by the end of the article, when he begins to suggest solutions to the problems, he completely abandons the careful reasoning with which he began.Ginzberg starts out by touching on the myriad social dilemmas—poverty, crime, violence, social dislocation—that have produced the present levels of chaos in our cities. He notes how all these factors have contributed to the collapse of the urban health care delivery system.Then in a curious reversal of his own thinking, he bases all his hopes for reform on changes in the medical system. He cites "long-term trend of abandonment and avoidance by physicians" of urban areas as if this was a cause rather than an effect. He calls for physician relocation as part of his solution.Where

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