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Letters |

Health Care Actors: The Patients' Feet Are Tied-Reply

Thomas Bodenheimer, MD; Kevin Grumbach, MD
JAMA. 1995;274(19):1509-1510. doi:10.1001/jama.1995.03530190023026.
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In Reply.  —Alas, would that Mr Kessler were right. But wishing something to be true does not make it true. Patients should be the main actors on the health care stage, but they are not. To cite just one example: for decades, the American public has overwhelmingly supported universal health insurance, yet we have no universal health insurance.One way in which patients traditionally exercised individual power was to vote with their feet: if they did not like a physician, they could find another. With many large employers (the major payers of care) now restricting free choice of physician, families are losing even the basic right to choose their own health care provider.The narrowing of individual choice is one side of the loss of patient clout in the health care system. Equally important is the issue of power that patients as a group might hold; for example, in the


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