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A National Health Program

James E. Casanova, MD; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH
JAMA. 1990;263(18):2445-2446. doi:10.1001/jama.1990.03440180043012.
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To the Editor.—  The need for a more efficient, accessible, and friendly health care system has been recognized since the time of Bismarck. Drs Woolhandler and Himmelstein's1,2 sincere and persuasive commentaries concerning a proposed national health program are of interest to me as one who had the opportunity to endorse this plan but declined.The proposal has much to recommend it, particularly its relative simplicity. However, it is unlikely that our society will choose such a cataclysmic change, given the current political and economic climate. Thomas Jefferson argued that government should do for people only what they cannot do for themselves. Our national culture still seems to espouse duplication and lack of central control whether we are talking about air travel, fast food, telephone service, or health care. This is not to say we should legitimize the status quo. Rather, the more likely scenario still seems to be a


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