To the Editor.
—Today's health care system is a paradox. On one hand, many health care professionals enjoy the confidence and gratitude of patients and family members. On the other hand, US citizens distrust insurance companies and "health care organizations," characterized by financial and legal manipulation rather than by interest in delivering an essential national service. Nothing short of fundamental change in the current scenario will truly relieve user fears, payer frustrations, and unwelcome pressures on physicians.1Representative McDermott2 understands the difference between political posturing and truly reforming (fundamentally changing) the current scene. So does the American College of Surgeons (Surgeons back single payer. Am Med News. February 28, 1994:1). Managed competition is not reforming (ie, fundamentally changing) the existing scenario. It is simply the 1980s profit-taking "competitive" model warmed over. That model has done nothing to contain costs, and its effect on public confidence is reflected in
Thompson RE. Health System Reform: The Case for a Single-Payer Approach. JAMA. 1994;272(14):1102-1103. doi:10.1001/jama.1994.03520140031026