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May 9, 1990

The Runaway American Health Care System-Reply

Author Affiliations

Piedmont Hospital and Medical Center Atlanta, Ga

Piedmont Hospital and Medical Center Atlanta, Ga

JAMA. 1990;263(18):2447. doi:10.1001/jama.1990.03440180044016

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In Reply.—  Technically, Dr Burnside is right in pointing out that health care contributes a percentage of the gross national product rather than consumes it. We appreciate his semantic honing. Practically speaking, part of the resources consumed in this disproportionate "contribution" might well be used otherwise. Since the majority payer is not the beneficiary, the payer may prefer the word consumption.Dr Rodnick emphasizes and makes more explicit a point we tried to make by implication. We stated, "This system has reimbursed handsomely—thus fostering—technical procedural skills, while reimbursing parsimoniously— thus casting disfavor on—time-consuming careful patient evaluation and management skills." The reason we have so many subspecialists is that medical technology is out of control and certain subspecialists are the physicians who use this technology. Two of the suggestions we make in our article—control technology and adjust the reimbursement system so that it is more equitable—should lessen the number of subspecialists