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Health of the Public: The Private-Sector Challenge

Larry B. Lehman, MD
JAMA. 1996;276(24):1951. doi:10.1001/jama.1996.03540240029016.
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To the Editor.  —In response to the article by Mr Showstack and colleagues,1 I wish to bring to the authors' attention a poorly chosen title, rather than an erroneously focused article. "Health of the Public: The Private-Sector Challenge" is incorrect. The "challenge" of the private sector is maximum profitability; the challenge of the public sector is to "do good by doing well."By this time, more than a decade into the era of managed care, we should have learned a number of important lessons. First, health care is a business, managed as all other businesses; second, health care is a vendor to employers (business), and idealists (physicians, academics) will not be able to compete with pragmatists (business persons, venture capitalists) until they accept the first lesson.This is not to say that there isn't something special still left to our profession; there is. But, as I have been told, the social responsibility


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