MANY MISCONSTRUE US health system reform options by presuming that "trade-offs" are needed to counterbalance the competing goals of increasing access, containing costs, and preserving quality.1,2 Standing as an apparent paradox to this zero-sum equation are countries such as Canada that ensure access to all at a cost 40% per capita less, with satisfaction and outcomes as good as or better than those in the United States.3,4 While the efficiencies of a single-payer universal program are widely acknowledged to facilitate simultaneous cost control and universal access, lingering concerns about quality have blunted support for this approach.
See also p 797.
Quality is of paramount importance to Americans. Opponents of reform appeal to fears of diminished quality, warning of waiting lists, rationing, and "government control."5 Missing from more narrow discussions of the accuracy of such charges is a broader exploration of the quality implications of a universal health
Schiff GD, Bindman AB, Brennan TA, Schiff , Bindman , Bodenheimer T, Brennan , Clancy C, Fein O, Hellander I, Himmelstein DU, Murray LR, Rucker TD, Sable R, Scavorn J, Shansky R, Shaffer E, Slobodkin D, Tarzynski S, Woolhandler S, Young QD. A Better-Quality AlternativeSingle-Payer National Health System Reform. JAMA. 1994;272(10):803-808. doi:10.1001/jama.1994.03520100065035