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Having dealt with the health care system with serious illnesses in myself and both my aging parents I believe that you are underestimating the difficulty of evaluating quality of care. It is true, as you state, that the incentives currently are skewed in favor of high tech procedures and expensive medications, but once you remove these incentives, you are still left with the problem of defining and delivering quality care. Most serious medical problems have a technical dimension, a psychological dimension, and a cultural dimension and its difficult to evaluate care on all these levels. As I think you are very smart, I would like to know your thoughts on how to enhance and maintain high quality medical care.