I found your article “How America’s Health Care Fell 111” very instructive. As a practicing primary-care physician, while trying to clear up my desk of the ever-increasing amount of paper that the different insurance companies (including Medicare) require from me on a daily basis, I have many times wondered how it is that we got sucked into this mess that the insurance industry tries to sell us as “freedom of choice.” It is a shame that your otherwise balanced article fell very short when considering all the different health-care delivery options currently available. Besides the often criticized British National Health-Care Service, there are at least two other systems, both much more effective than the British or American models: one is the German and the other is the Canadian. Both have public funding as their only source of revenue, they both guarantee full access for every citizen (even when traveling abroad, at least on the Canadian system) while at the same time reimbursing their physicians on a fee-forservice basis so as to avoid the disincentive to work found on the British system and well described in your article. The only drawback that some of my colleagues would find in such a system is that it pays more for preventive and primary care medicine as opposed to procedural and superspecialized medicine (which is exactly what we need and what your article with the prematurely born-baby example illustrates very well). The paperwork is kept to a minimum and therefore so is the bureaucracy needed to shove it around. In a recent interview on National Public Radio, the head of the Canadian health-care system (which is very decentralized) explained that the head office is run with fifteen employees; that to order a new piece of equipment a hospital has to show the need for it in its area; and that the billing department of a typical Canadian hospital takes up only a couple of rooms of office space as opposed to this country, where it sometimes take whole floors.

Living free of the fear of personal economic catastrophe due to illness is part of the “pursuit of happiness” mentioned in our Constitution. That one of the richest countries on this planet is unable to provide adequate health care to all its citizens despite massive expenditure should shame us all.