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Market Reforms for the Health Care System

Fredric M. Steinberg, MD, MBA
JAMA. 1996;275(10):755. doi:10.1001/jama.1996.03530340019012.
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To the Editor.  —In his thoughtful Commentary,1 Dr Ginzberg points out several important issues that need to be addressed in any informed debate about changing the status quo in health care. However, Ginzberg relies on some incorrect assumptions that bias his arguments against free market solutions.While discussing the current emphasis on the free market, Ginzberg includes managed care company executives among its enthusiasts. These executives, whose jobs exist because of government interventions such as the HMO [health maintenance organization] Act of 1973 and a current tax code that distorts free choice in insurance decisions, are no friends of the free market and, in fact, consistently oppose free market reforms. It is government decrees that have promoted the growth of these entities, whose incentives to physicians additionally make them no friends of patients.Ginzberg asks why, if "the market has had wide scope to 'do its thing' for the


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