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The Inevitable Failure of Cost-Containment Strategies

Frank E. Samuel Jr
JAMA. 1987;257(15):2029-2030. doi:10.1001/jama.1987.03390150045008.
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To the Editor.—  Dr Schwartz1 keeps reminding us that health care ration cards are inevitably just around the bend because of our insatiable appetite for health care services and technologies that are very expensive and perhaps fundamentally useless.Although much of what Dr Schwartz says is thoughtful, in at least two respects he is wrong. First, he seems impervious to the alleviation of human suffering made by technologies that make but a marginal change in the big picture. He discusses with extraordinary superficiality advances like coronary angioplasty that make a modest, but real percentage of coronary artery bypass surgery actually—as opposed to statistically—unnecessary. He discusses this particular advance as meaningless, apparently because it isn't important enough to change the big picture. No matter that many candidates for bypass surgery need not endure, among other things, having their breastbones cut down the middle by a surgical saw. And if the


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