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May 18, 1994

The United States Needs a Health System Like Other Countries

Author Affiliations

Southern California Permanente Medical Group Pasadena

JAMA. 1994;271(19):1480. doi:10.1001/jama.1994.03510430032016

To the Editor.  —The article by Dr Glaser,1 which recommends a "genuine national health insurance system," dismisses criticisms that such a system leads to "backward technologies, waiting lists, [and] underpaid... physicians," but does not provide any justification for that dismissal. On the other hand, one can readily justify the criticisms. For example, a recent article2 stated that France provides dialysis to 88% fewer of its citizens than does the United States, and physician income is only 30% of the US level. Short visits and long waiting lists are a feature of every national health insurance system. These facts should make one pause before recommending a change. What is the virtue of correcting the United States' sin of high expenditures by substituting the sin of inadequate expenditures under a government-mandated global budget?Similarly, the article summarily dismisses the proposed middle ground of managed competition. The author states that hospital