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September 26, 1977

Rising Cost of Medical Care-Reply

Author Affiliations

Boston City Hospital Boston

JAMA. 1977;238(13):1361-1362. doi:10.1001/jama.1977.03280140039005

In Reply. —  Dr Bader has raised some interesting points regarding the future of Medicaid. However, it is difficult to generalize from his experiences. For example, he and his colleagues have been fortunate enough to work in a hospital (Seattle-King County) that is able to provide care that "has technically been good, often excellent." I interpret this to mean that this hospital has good physical facilities. Unfortunately, this is not true of many city, county, and state hospitals, particularly in large urban areas with a history of neglect. Many of these hospitals are staffed or supervised by medical school faculties. The quality of medical care is good, but the physical facilities are inadequate.Dr Bader describes a special prepaid health insurance program using Blue Cross-Blue Shield for residents of the ghetto area in Seattle. He admits that this program has taken patients away from the county hospital: "Some even elect