Memorandum regarding DCI Computing
.PP
It is important to recognize this as an economic,
as a financial problem,
and not to be distracted by the mystique of the
ununderstood technology.
.PP
There is no reason to anticipate that the proposed
computing system will increase the quality of care.
But even if it were possible that the computing system
might increase the quality of care,
it is essential to recognize
that the focal issue in contemporary hemodialysis
is not improving quality of of care,
however desirable this might be,
but to reduce costs to optimize the number of patients
to whom the technology is available.
The rationing of health care is no longer on the horizon:
it is already here.
The public has already decided
that it is unwilling to provide maximal health services
for everyone,
and, as elsewhere,
funds for treating the sickest of our patients
are going to be denied.
Under these circumstances it behoves us 
to do everything possible to diminish our fixed expenses.
And the proposed computing system
is probably not a way to do that.
.PP
Turning now to the proposed computing system itself,