July 2, 1997

Professionalism vs Commercialism in Managed Care: The Need for a National Council on Medical Care

Author Affiliations

University of California, San Francisco

JAMA. 1997;278(1):20. doi:10.1001/jama.1997.03550010034020

To the Editor.  —Drs McArthur and Moore1 present an important and timely discussion of the tension between the professional and commercial traditions in health care delivery and of the need for a national agency to monitor this antagonistic state. However, I disagree with their implicit notion that physicians refused to yield to commercial pressures until only recently forced to do so in the present era of managed care and cost containment. Respecting the existence of the physician "who values the patient's welfare above his or her own," the annals of American medicine reveal that many physicians both individually and collectively often deliberately sought to maximize their financial gain at the expense of patients, nonphysician practitioners, and the public.2,3This fact drives the urgent concern for minority populations who are at particular risk for substandard care at a time when physicians are more intensely pressured to protect their own