“Improving Chronic Illness Care: Lessons Learned in a Private Practice” [November/December 2005] is a valiant and important article. As it demonstrates, good medicine is not cost-effective on the caregiver end. Dr. Phil Mohler’s group must be making a far better living in Colorado than I did in Northern California to be able to sacrifice $1,800 a year to implement a diabetes management system. It’s not just that payers reimburse short, symptom-focused care (sprains, colds and the like), but this is reimbursed far more than teaching, and getting patients with diabetes to cooperate for their own survival requires a lot of teaching. Just think, the efforts of Dr. Mohler and his practice don’t even begin to address other chronic illnesses.