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October 12, 1994

Health System Reform: The Case for a Single-Payer Approach

JAMA. 1994;272(14):1101-1102. doi:10.1001/jama.1994.03520140031022

To the Editor.  —Representative McDermott's1 article advises us to throw out the myths of the past to embrace a single-payer system. If we first throw out the Madison Avenue nomenclature, then we can turn to the lessons of the past, not the myths, to consider the supposed virtues of socialized medicine.One of those lessons is that socialized medicine leads to rationing as surely as our current system.2 A second lesson is that government does not keep its promises. If you doubt this, recall that governmental promises that Medicare would pay usual, customary, and reasonable fees were out the window in less than 20 years. Budget pressures have led Medicare to progressive restrictions on allowable procedures and use of assistants and to reduced fees for many procedures. Once there is full government control of the entire health sector of the economy, all promises made now about how the