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The Costs of Doctoring, the Distribution of Physicians, and Caring for the Underinsured

James A. Albright, MD
JAMA. 1991;266(11):1510. doi:10.1001/jama.1991.03470110056019.
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To the Editor.  —The articles in a recent issue of JAMA on the cost of medical care in Canada1 and in this country2 are misleading. Both report that medical costs increase as the number of physicians increases. The "solution" recommended is to ration medical care and to limit the number of physicians.There are two major problems with these articles, the most serious being the economic concepts. The other is philosophic and attitudinal.The underlying assumption considers the market system ineffective (and immoral) when applied to medical care. But the market system has been nonexistent in medicine for many years. Apparently, this creates the right to eliminate it a priori from serious consideration.A market system requires a consumer. The only valid consumer is the patient, but the patient has been replaced by third parties. As a result, neither patients nor physicians have much concern over costs because


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