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In Reply: Dr Palmisano incorrectly equates our proposed NHI with Canada's. The United States spends 75% more per capita on health care than Canada and 145% more than Britain¹; our higher spending would (and should) persist under NHI. Underfunding in Canada has caused some waits and shortages, which have been exaggerated in the US press.² Nonetheless, levels of satisfaction with the Canadian health care system are similar to those in the United States.^{1, 3} We believe that Canada spends too little on health care, but gets great value for money. While Canadians appropriately criticize their system, they overwhelmingly support it.⁴

Palmisano views the perpetuation of private insurance firms as essential to freedom. We disagree. An NHI program would regulate publicly funded hospital expansion, not prohibit it. His assertion that NHI would amplify intrusive bureaucracy is puzzling; US health maintenance organizations (HMOs) are world champions at hassling physicians.³ The research literature . . . [Full Text of this Article]

Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD; Marcial Angell, MD; Quentin D. Young, MD for the Physicians' Working Group for Single-Payer National Health Insurance

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