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May 9, 1990

A National Health Program-Reply

JAMA. 1990;263(18):2446. doi:10.1001/jama.1990.03440180043013

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In Reply.—  Our health care system must and will change. Too many are denied care, costs continue to rise unchecked, and health bureaucracy consumes an ever greater proportion of our time and money. No reform can both ensure unlimited access to every imaginable high-technology service and contain costs while subsidizing the world's most expensive and least efficient health care payment apparatus. We believe a Canadian-style system represents a reasonable balance among competing priorities.Dr McDougall acknowledges the Canadian system's popularity and lack of bureaucracy, but is concerned that rising patient demands and finite resources may eventually undermine the quality of care, although the shortcomings he cites seem minuscule by US standards. The conflict between need and cost is common to all health care systems. The United States deals with this conflict through an army of bureaucrats reviewing care on a case-by-case basis and rationing care based on ability to pay.