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December 15, 1993

Mandatory National Health Service

JAMA. 1993;270(23):2807. doi:10.1001/jama.1993.03510230043021

To the Editor.  —Saying that "Health care reform is now a national priority," Dr Johns1 points to a few of the myriad personnel, organizations, monies, and so on that must be inducted, articulated, and bossed to turn today's laissez-faire into tomorrow's regimentation. He expects government to dominate this metamorphosis and beyond. Government will assign, bankroll, mete, appraise, and dispose the physician from freshman gross anatomy class to retirement.To anticipate the impacts of such a medicine program, I look at the variegated programs outside medicine that are run or dominated by federal, state, or local government. It is easy to conjure up a res publica with metaphoric legs and genitals beleaguered by elephantiasis—the inevitable end point of burgeoning infestation by parasitic government and its protégés.Our heavy-legged nation already drags, staggers, and stumbles under the weight of current infestations. Must it now bear yet another plethora of parasites—which just