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October 31, 1977

Cost of Medical Care

Author Affiliations

Children's Orthopedic Hospital and Medical Center University of Washington School of Medicine Seattle

JAMA. 1977;238(18):1911. doi:10.1001/jama.1977.03280190013003

To the Editor. —  In regard to "A Prescription for the Rising Cost of Medical Care" (237:2383,1977), Vernon Mark, MD, has certainly succeeded in his aim of promoting debate. Unfortunately, his prescription is about as archaic as would be one prepared in the 1930s to treat a septic patient in the 1970s. For example, only after he has mentioned "outpatient care" four times does he drop the phrase "office setting"; apparently Dr Mark is unaware of the horrendous record of outpatient settings—particularly in municipal, county, and state hospitals—in terms of their nonresponsivity to patient care needs and their costs double to triple those of private office medicine. Also, does he, a neurosurgeon of all people, really advocate that all physicians be compensated at a uniform rate based on time? As a pediatrician, I might champion the concept, though it does ignore market place forces.Most provocative is his indictment of