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May 18, 1994

The United States Needs a Health System Like Other Countries-Reply

Author Affiliations

New School for Social Research New York, NY

JAMA. 1994;271(19):1482. doi:10.1001/jama.1994.03510430032022

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In Reply.  —Like most journal articles, mine summarized the highlights. I offered a reform whose actual operations could be demonstrated abroad. Several letters argue that those systems are defective. We should now proceed to thorough analysis of actual facts from the countries with national health insurance—a task too extensive for short articles and letters. However, I offer plentiful evidence about such operations in my books and the articles I cited, based on decades of firsthand field research abroad.Several objections are incorrect; my publications and files present the full story. Per capita utilization under national health insurance is not obstructed, but usually exceeds that of the United States. If some services are used less (such as dialysis in France), the reason is not the financing system— which covers them—but the clinical practice styles of the physicians. Shortages of high-tech facilities and waiting lists occur in some countries with full public

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