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—I would like to thank Julian M. Morris for his thoughtprovoking rebuttal to my editorial. I agree with Mr Morris that physicians are not blameless or helpless regarding the negative changes that have occurred in medicine. I did not intend to portray them as such. However, I do not accept his belief that the government is blameless for many of the problems in medicine and ophthalmology today.One obvious example of the government's negative impact on medicine is the Medicare system. Medicare has probably done more to induce physicians to look for ways to get around burdensome bureaucratic controls than any single entity. Medicare codes and allowances for various procedures are totally incomprehensible. Reimbursement is not related to expertise, time, training, or the result of a procedure. The system encourages the cheapest and poorest quality of medical care as it "all pays the same." Only quantity, not quality,
Anderson RL. Eyelid Tattooing-Reply. Arch Ophthalmol. 1986;104(3):335–336. doi:10.1001/archopht.1986.01050150028009
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