To the Editor:

It is not the fault of George Bernard Shaw that he was unable to follow his line of reasoning a little further (see his quote from The Doctor's Dilemma, July/August 1997, p. 27). An unreconstructed socialist, Shaw notes that “you could provide of the supply of bread by giving bakers a pecuniary interest in baking for you” but was unwilling to extrapolate what would happen to the bread supply if the baker had no pecuniary interest in baking for you.

Adam Smith could have informed him of the likely outcome. Indeed, the current famine in North Korea and the collapse of the Soviet Union and its eastern European empire bear eloquent witness to the results of uncoupling work and economic incentive.

While unrestricted fee for service may indeed provide perverse incentives to cut “your inside out,” the kind of harassment, micromanagement and fee cutting documented in this magazine provides incentives of another sort that could eventually do to medical care what not paying the baker would do to the bread supply.