Sir.—The May 1991 issue of AJDC, with the impressive articles by outstanding leaders in the field, was most interesting. Unfortunately, most wanted to put more money and effort into the plight of children without asking anything in return! Twenty-five years after a marked increase in social expenditures, we are worse off because we did not ask anything in return!
Hinman1 was the only author who suggested it may not be just money, but "incentives, either positive or negative." Cleveland,2 Stahlman,3 Haggerty,4 and Blum and Blank5 touched on rationing, jobs, and lack of accountability. Conspicuously absent was Louis Sullivan, Secretary of Health and Human Services of the United States, who is outspoken on changing life-styles for better health and on individuals taking some responsibility. Many nationally prominant persons have pointed out our finite resources as a reminder that spending here means taking away there.
HECKER JA. Health Care for Uninsured and Underinsured Children. Am J Dis Child. 1991;145(10):1086. doi:10.1001/archpedi.1991.02160100017006