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To the Editor: I would take Mr Lamm's¹ thesis that "government cannot possibly afford to underwrite all the health care needs of an aging society" more seriously if he applied the same budgetary principles to military spending. Without that, his proposal is just political rhetoric.

Eric R. Houghton, MD
Medical Assistance Administration Olympia, Wash

1. Lamm R. Marginal medicine. JAMA. 1998;280:931-933. FREE FULL TEXT

To the Editor: I found Mr Lamm's article¹ interesting. However, medicine has always dealt with the individual patient (humanistic medicine). It has never been utilitarian (thinking about the greatest good for the greatest number). Utilitarian individuals would not go into medicine, as it makes no sense to spend $30,000 for a kidney transplant or coronary bypass on a 40-year-old man, or for any treatment when that same $30,000 would feed and clothe dozens of starving children and provide them with vaccinations and basic health care. Is the new managed care medicine truly utilitarian? Managed care now . . . [Full Text of this Article]

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Marginal Medicine
Richard D. Lamm
JAMA. 1998;280(10):931-933.
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