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May 9, 1990

A National Health Program

Author Affiliations

Calgary, Canada

Calgary, Canada

JAMA. 1990;263(18):2445. doi:10.1001/jama.1990.03440180043010

To the Editor.—  The commentary on a national health plan by Drs Woolhandler and Himmelstein was very interesting.1 It was, however, simplistic and perhaps naive.I have both a personal and a business overview of the American health care provision systems. In addition, after 15 years in private practice in Canada, I believe I know our system well. There is no doubt that America spends too much on health care and has an unwieldy bureaucracy to contend with. There is also no doubt that this increased expenditure does not translate into increased wellness or better mortality and morbidity rates. Changes to America's health care provision systems are overdue and inevitable.The authors of this commentary have suggested a "single tax-funded comprehensive insurer." Presently, in Canada, this insurer is government, which, I assume, would also be Drs Woolhandler and Himmelstein's choice. There is no doubt that this national health program