The United States Needs a Health System Like Other Countries

Ole J. Thienhaus, MD
JAMA. 1994;271(19):1482. doi:10.1001/jama.1994.03510430032021.
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To the Editor.  —The article by Dr Glaser1 on health system reform was remarkably lucid and thoughtful. I would like to add two comments. First, I believe that Glaser's concept is quite compatible with a single-payer model. Universal social insurance does not need to be the treasury (as it is in Canada). On the other hand, I see no advantage in a multiplicity of social insurances if we agree that classical market dynamics are not relevant to the problem. I am aware that in Germany, for instance, there are multiple sickness funds for historical reasons. Working in that system for 2 years as a primary care physician was fine, but having to use different prescription forms depending on the kind of sickness fund responsible for the patient was time-consuming and inconvenient. That inconvenience is not matched by any noticeable advantage to patient, provider, or any other component of the


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