A Better-Quality Alternative

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.¹,²Standing 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.³,⁴While 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."⁵Missing from more narrow discussions of the accuracy of such charges is a broader exploration of the quality implications of a universal health