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January 25, 1995

Health System Reform: Will Controlling Cost Require Rationing Services?

Author Affiliations

Mount Sinai School of Medicine New York, NY

JAMA. 1995;273(4):285-286. doi:10.1001/jama.1995.03520280028026

To the Editor.  —Dr Eddy's outstanding analysis of the health system apparently accepts the conventional wisdom method of allocating medical costs.1 This, in overly simplistic terms, is akin to the "captive syndrome" where the prisoners begin to identify with their captors. McGinnis and Foege2 have reclassified the leading causes of death (and indirectly morbidity and health care cost) and estimate, for example, that 400000 deaths (19%) per year are related to tobacco use, 300 000 (14%) are related to diet and activity patterns, 100 000 (5%) are alcohol associated, 35000 (2%) are caused by firearms, and so forth. Much of this mortality and morbidity is related to the socioeconomic status of the victim.The issue thus becomes where on the balance sheet should one place the cost of dealing with this societal burden? In recent years the medical profession has accepted the results of societal and individual imprudence

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