I appreciate the interest shown in my commentary, "Medical Refugees in America."1 Besides the 3 letters published here, I received approximately 15 personal letters commenting on the article. Most of the letters were in agreement with my observations, including a number of communications from primary care physicians who confirmed what I have long held, ie, for-profit health maintenance organizations apply considerable pressure, both economic and otherwise, to encourage physicians to reduce the patient's appointment time, the number of diagnostic tests, and the number of therapeutic interventions.
Alpert JS. Health Care for Sale—Reply. Arch Intern Med. 2000;160(17):2682–2683. doi:
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