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To the Editor: Drs Emanuel and Fuchs¹ overlooked a major element contributing to the high cost-benefit ratio of the US health care system: government regulation. Given a system that must deal with such things as ERISA, EMTALA, HIPAA, Sarbanes-Oxley, the FDA and DEA, state health departments, licensing agencies, the Joint Commission, and many others, this needs to be factored into the cost structure. A 2005 analysis concluded that there was a regulatory cost of $3000 to $4000 per health care employee.²

Financial Disclosures: None reported.

Charles A. Pilcher, MD
chuck@pilchermd.com
Emergency Department
Evergreen Hospital Medical Center
Kirkland, Washington

1. Emanuel EJ, Fuchs VR. The perfect storm of overutilization. JAMA. 2008;299(23):2789-2791. FREE FULL TEXT 2. Crain WM. The impact of regulatory costs on small firms: Small Business Research Summary No. 264, September 2005. Small Business Administration Web site. http://www.sba.gov/advo/research/rs264tot.pdf. Accessed August 20, 2008.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;300(19):2251.

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