Greed in US Health Care—Reply

In Reply I thank Dr Back for his Letter, and I agree with him. My Viewpoint was indeed directed mainly to JAMA’s core readership—physicians, but the problems created by a profit-driven health care system go far beyond physicians in both cause and effect. Back’s critique triggers the provocative question as to whether health care ought to be market driven in the first place, and, if not, what it will take to change the status quo. In their recent book, The Big Myth: How American Business Taught Us to Loathe Government and Love the Free Market, historians Naomi Oreskes and Erik Conway find the foundation to be poor, indeed, for the market fundamentalist view that capitalism and freedom are indivisible. They quote George Soros, who questioned “the doctrine of laissez-faire capitalism…[which]...holds that the common good is best served by the uninhibited pursuit of self-interest.” In my view, the state of US health care bears strong witness to the bankruptcy of that doctrine. The bad news is that market fundamentalism is so strongly entrenched in the care system that, as Back states, only a wide coalition stands a chance of overturning the myth.