"A few years ago I realized that my bonus, based on my "quality" management of diabetes, was compromised by the poor quality of my patients. I then dismissed many of the alcoholics and non-compliant (more correctly, I maneuvered them to dismiss me -- much less hassle); and my bonus scores have greatly improved. I thought I was clever, but I've come to believe that this is exactly what the the network, the insurance companies, and the gov't, wants me to do."
"One might as well claim that the tide which rubs pebbles smooth on a beach is doing the pebbles a service because being round is prettier than being jagged. It's of no concern to a pebble what shape it is. But it's very important to a person."