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March 9, 1994

Evaluating Health System ReformThe Case for a Single-Payer Approach

JAMA. 1994;271(10):782-784. doi:10.1001/jama.1994.03510340072037

THROUGHOUT history, the medical profession has struggled in its conflict between belief and science. In the late 18th century, this struggle was exemplified by a religious adherence to Dr Benjamin Rush's theory that bleeding patients would restore health. The result of this mistaken belief—as opposed to proven hypothesis—was that George Washington is historically thought to have been bled to death therapeutically.

Two hundred years later, American medicine is still locked in its ambivalence between science and belief. But in 1993, the issue is health care system reform. In the debate emerging from the presentation of President Clinton's plan, the challenge for our profession will be whether it can move beyond time-honored mantras to examine objectively and scientifically the options with which it is presented.

THE NEED FOR CHANGE  Few would dispute the need for change. American physicians are the most dissatisfied and frustrated in the industrialized world.1 Approximately 15%

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