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May 18, 1994

United States Health Care System Reform: An Era of Shared Sacrifice and Responsibility Begins

JAMA. 1994;271(19):1530-1533. doi:10.1001/jama.1994.03510430084040

My Way  If I were starting an American health care system from scratch in 1994, this is what I would do. All persons would have a primary care physician of their own choosing, who would provide comprehensive continuing care and refer as appropriate. I would emphasize prevention and early detection of disease; proven interventions, such as immunizations, Papanicolaou tests, and mammography after age 50 years, would be free to patients and paid for by government tax revenues. Specialty and subspecialty physician care would be by referral only. All ambulatory care provided by physicians and other health care professionals or organizations would be paid by patients out of pocket, up to some annual legal maximum (perhaps $3000 per person). Patients would be expected to pay their bills. Physicians and other providers would be expected to provide a reasonable amount of free care or offer reduced charges for medications, diagnostic tests, and