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Dr Kal appears fearful that the proposal for linking reimbursement to informed consent contained in my article might actually be successful in saving some money for the health care system. While he is surely right that motives ought to be scrutinized (I can only testify about my own) and that cost savings should not be sought or achieved at the cost of patient welfare, I reject the idea held by many physicians that any strategy that saves money in health care delivery, whether intentionally or incidentally, must inherently be evil. Contrary to the assertion that cost-containment "devils" like myself always prevail in shaping policy, the medical establishment has been quite successful in accomplishing a steady, significant, uninterrupted escalation in health care spending in the United States. It is this escalation that potentially threatens the clinical autonomy and economic income of physicians in the future at the hands of
Kapp MB. Linking Payment for Care to Informed Consent-Reply. JAMA. 1989;262(15):2091. doi:10.1001/jama.1989.03430150051017