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December 7, 1994

JAMA Editorial Position and US Health System Reform

JAMA. 1994;272(21):1655. doi:10.1001/jama.1994.03520210039015

To the Editor.  —Dr Lundberg's1 wish list for US health system reform rests on belief in a nonexistent medical marketplace. The actual marketplace is a classic example of supply-side economics. Practicing physicians, one component of the actual marketplace, set their own fees in a way not to threaten those of their colleagues. There are practically no market pressures that would lower prices. When we physicians order tests, prescribe drugs, or schedule procedures, it is the rare patient who can effectively raise objections. The actual marketplace has placed physicians' incomes in the top 1% of incomes in the nation.Lundberg rates the single-payer health plan zero on the physician-liability question. The truth is that the single-payer plan would eliminate large awards for out-of-pocket health care expenses for iatrogenic disabilities, and this fact alone should lower liability insurance costs.But the major problem in the Editorial is the uncritical approach taken