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Previous Volume 355:2595-2598 December 14, 2006 Number 24 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: In his Perspective article (Aug. 31 issue),¹ Bodenheimer accurately describes the assault on primary care medicine. Insurers deny payment and bureaucrats add onerous record keeping, while the needs of patients increase. We persist only because of the rewards that are documented in the accompanying Perspective article by Woo.²

It seems unlikely that macrosystem improvement will occur in the near future. For small practices, rhetoric about efficiency and quality produces more problems than solutions. Pay for performance is a good example. In the 1990s, the "golden age" of health maintenance organizations and capitation, my partner and I were . . . [Full Text of this Article]

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