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October 12, 1994

Health System Reform: The Case for a Single-Payer Approach

Author Affiliations

Alton, Ill

JAMA. 1994;272(14):1102. doi:10.1001/jama.1994.03520140031024

To the Editor.  —Representative McDermott's1 comments regarding a Canadian single-payer system for US health care reform relies on altruism and does not reflect the reality of the system. I am a third-generation physician, born and raised in the Canadian health care system, and I have seen the single-payer system in Canada develop and flounder under a burgeoning economic crisis. Patient access is not unfettered with free choice of provider. Access is limited by excessive patient loads on primary care physicians and limited specialist availability, making 2-month and 3-month referral waits common. Global budgets and caps have not been effective at cost containment as the Canadian health care system has experienced medical cost increases parallel to that of the United States. The only effects of global budgeting are economic rationing of care through closure of hospital beds, limiting of diagnostic equipment, and long waiting lists for elective surgery. Negotiations with

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