To the Editor: Dr Woolhandler and colleagues, on behalf of the Physicians' Working Group for Single-Payer National Health Insurance,1 argued for the establishment of single-payer national health insurance (NHI). Details of their proposal—to require that physicians negotiate a binding fee schedule, prohibit hospital expansions and capital purchases, eliminate the health insurance industry, and require employers to transfer money earmarked for health benefits to the NHI program—represent the antithesis of freedom, choice, and private enterprise, the very hallmarks of American society.
Single-payer, government-run health care cannot deliver the best medical care that Americans expect and now receive. Inherent problems include detrimental long waits for care, rationing, a slowness to adopt new technology and maintain facilities, and a gigantic bureaucracy that interferes with clinical decision making.
The authors' continual references to the merits of the Canadian health care system contrast sharply with a recent report by Canadian physicians that concludes "we see continued turbulence . . . as a growing portion of Canadians lose patience with health care systems that they perceive as no longer delivering reasonable access to core services."2 Aaron3 has recently described analytic flaws in the analysis of Woolhandler and colleagues of differences between US and Canadian health care administrative costs, which form the basis of their methodology for single-payer national health insurance.
In June 2003, the Chairman of the British Medical Association characterized his nation's single-payer health care system as "the stifling of innovation by excessive, intrusive audit . . . the shackling of doctors by prescribing guidelines, referral guidelines and protocols . . . the suffocation of professional responsibility by target-setting and production-line values that leave little room for the professional judgment of individual doctors or the needs of individual patients."4 His strong words come from long experience with a single-payer health system.
In his Editorial, Dr Fein issued a challenge to those who reject the single-payer "solution"—present a better and stronger one as an option.5 The American Medical Association has a strong and viable solution—one that does not limit the universe of choices and that does not dictate a single-payer system as the only escape from managed care abuses. Our plan builds on current health care strengths and various options to ensure that Americans are covered by health insurance.6
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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