To the Editor.
—The article by Dr Bindman and colleagues1 and the Editorial by Dr Starfield2 conclude that improving access to care will reduce hospitalization rates for chronic conditions. The authors meticulously evaluated physician behavior by practice style and admitting criteria, but inexplicably ignored a far more important variable: disease-inducing patient behavior. Tobacco use, dietary factors, activity patterns, misuse of alcohol, and illicit drug use account for almost 40% of all deaths in the United States3 and are directly linked to the five medical conditions evaluated by Bindman et al (asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and hypertension).Contrary to the authors' conclusions, I postulate that access to care has reached the point of diminishing returns. The United States dedicates 13% of its gross domestic product to health care,4 the highest in the world. Additional increments in access to medical care will