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To the Editor: In their article on disclosure of physician financial incentives,¹ Ms Miller and Dr Sage mention in passing the possibility that fee-for-service medicine may "lead to inappropriate care," but the remainder of their article is lopsidedly biased against capitated medicine. The words "managed care" appear no fewer than 26 times, always in a critical context, while the term "fee-for-service" is used only 7 times, and then tangentially. There are also 11 references to health maintenance organizations (HMOs), underuse, and incentives to limit treatment, but none to overuse and its clinical and economic risks. There is no meaningful discussion of the devastating consequences of excessive and unnecessary care, which is powerfully incentivized in the fee-for-service world. This bias, and its amplification by a hysterical media, have rendered it almost impossible for health care to be managed intelligently today. Any decision not to implement a consultation, procedure, or treatment, no . . . [Full Text of this Article]

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