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November 3, 1999

Managed Care, Charity Care, and the Common Good—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(17):1619-1621. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-17-jbk1103

In Reply: The letters' authors chide me for not going far enough in criticizing the present system. Fair enough. Many other problems should be mentioned. Drs Pollner and Wooten are right that the increase of corporate values in medicine, where patients are customers and professionals are employees,1 threatens standards of behavior that society has long expected of health care practitioners, such as putting the patient first and self-regulation.2 I agree with Dr Volpintesta that malpractice and cost-containment are at cross purposes. Physicians are discouraged from making tough decisions about services with marginal benefits, or even from withholding futile treatments, when they can be sued for doing so. Finally, as Mr Yarmolinsky points out, money spent on marketing and paying investors is lost to patient care. However, administrative efficiency in the United States was low even before the managed-care era.3