Caring for the Uninsured and Underinsured

Abstract

To the Editor. —As a public hospital physician overwhelmed by the growing number of indigent and uninsured patients, I want to thank you for devoting the May 15 JAMA issue to health care reform. The articles were most informative; Dr Lundberg's editorial 1 was inspirational. Although several viewpoints regarding reform were presented, all overlooked a major component in the quest to build a more just health care system. While I concur that the discussions of different possibilities of payer mixes and administrative structures are, in fact, central to any basic reform, provider mix, perhaps the most important element in a rational delivery system, was not discussed. There is a consensus that at least 50% of the providers must be in primary care—family medicine, general internal medicine, or general pediatrics—if our goal to develop a cost-effective system with universal access to basic services for all is to be achieved. I note