To the Editor.
—While generally agreeing with Representative McDermott1 on the need for a single-payer approach to health system finance, I would point out a fundamental flaw in his plan. I was particularly surprised at this missing element given that the author has worked overseas and had the opportunity to observe health care systems in a number of countries. The examples he cites of single-payer systems are, in fact, not. In every case, while the government coordinates the bulk of health care expenditures, individuals retain the right to directly purchase health care services outside the governmental financing mechanism and may do so without penalty. In Australia, this is what is meant by "right of private practice." In England, the National Health Service has occasion to buy surgical services from the private sector when it is overloaded. Throughout the Middle East and Africa, when the wealthy want a medical service,
Brickfield FX. Health System Reform: The Case for a Single-Payer Approach. JAMA. 1994;272(14):1101. doi:10.1001/jama.1994.03520140031021