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    Health care reforms are tricky when profit motive interferes

    Jeffrey D. Sachs (“Disparities and high costs fuel health care crisis,” Opinion, Oct. 24) has written an excellent overview of what makes the American health system so inadequate, inequitable, and expensive, compared with other advanced countries, and he recommends some important reforms. But one of them — paying providers a set yearly amount for each patient covered (capitation), instead of paying on a fee-for-service basis — would not work in this country, because, unlike other countries, our providers are largely for-profit (or behave that way).

    In a capitated system, providers could therefore make money by undertreating the patients on their roster, just as they now benefit in the fee-for-service system by doing unnecessary tests and procedures.

    Although less costly, undertreatment is just as bad for patients as overtreatment. A reformed system should have predominantly nonprofit providers, so they couldn’t benefit either from overtreatment or undertreatment.

    Dr. Marcia Angell, Cambridge