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Single-Payer National Health System Reform

Gordon D. Schiff, MD; Andrew B. Bindman, MD; Troyen A. Brennan, MD, JD, MPH; Physicians for a National Health Program Quality of Care Working Group; Dr Schiff; Dr Bindman; Thomas Bodenheimer, MD, MPH; Dr Brennan; Carolyn Clancy, MD; Oliver Fein, MD; Ida Hellander, MD; David U. Himmelstein, MD; Linda R. Murray, MD, MPH; T. Donald Rucker, PhD; Ron Sable, MD; Jeffrey Scavorn, MD; Ronald Shansky, MD; Ellen Shaffer, MPH; David Slobodkin, MD, MPH; Steve Tarzynski, MD, MPH; Steffie Woolhandler, MD, MPH; Quentin D. Young, MD

JAMA. 1994;272(10):803-808.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

MANY MISCONSTRUE US health system reform options by presuming that "trade-offs" are needed to counterbalance the competing goals of increasing access, containing costs, and preserving quality.^1,2 Standing as an apparent paradox to this zero-sum equation are countries such as Canada that ensure access to all at a cost 40% per capita less, with satisfaction and outcomes as good as or better than those in the United States.^3,4 While the efficiencies of a single-payer universal program are widely acknowledged to facilitate simultaneous cost control and universal access, lingering concerns about quality have blunted support for this approach.

See also p 797.

Quality is of paramount importance to Americans. Opponents of reform appeal to fears of diminished quality, warning of waiting lists, rationing, and "government control."⁵ Missing from more narrow discussions of the accuracy of such charges is a broader exploration of the quality implications of a universal health . . . [Full Text PDF of this Article]

Author Affiliations
From the Division of General Medicine/Primary Care, Cook County Hospital, Chicago, Ill (Dr Schiff); the Division of General Internal Medicine and the Institute for Health Policy Studies, San Francisco General Hospital, University of California—San Francisco (Dr Bindman); and the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (Dr Brennan). Dr Bindman is a Robert Wood Johnson General Physician Faculty Scholar.

Footnotes
A complete list of the members of the working group that drafted this report, which was then reviewed and endorsed by Physicians for a National Health Program, a national organization representing more than 6000 physicians, appears at the end of this article.

Reprint requests to Physicians for a National Health Program, 332 S Michigan Ave, Suite 500, Chicago, IL 60604 (Dr Schiff).

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