Wayne Bradley
JAMA. 1987;258(16):2300-2301. doi:10.1001/jama.1987.03400160154050.
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The challenge to government and medicine that has been in process for more than a decade intensified during the past year. The challenge is to maintain access to and quality of care while containing costs.

Medicare and Medicaid were enacted to offer medical assistance to the elderly and needy without interfering with the private practice of medicine. The intention was to provide the benefits of private care to all citizens regardless of whether reimbursement was through private or public funds. Shortly after the programs began, their costs exceeded projections, and the government immediately began searching for ways to contain public-care costs while maintaining private-care quality.

Following that model, the second session of the 99th Congress closed last year with legislation that set Maximum Allowable Actual Charges for physicians who serve Medicare patients but who did not sign "participating" agreements to accept the program's assignment of fees. The legislation widened the


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