APA President Nada Stotland, M.D., responds:

Dr. Berger offers us a valuable view from the perspectives of his friends and relatives in Great Britain. Private-sector medical care has expanded there and overlaps with care provided under the National Health Service (NHS). For example, because of the shortage of NHS beds, 80 percent of the beds in the private sector are used for NHS patients. Also, some NHS consultants see private patients as well.

In most countries of the world, including the United States, people with sophistication, education, and money can get better care than those without. My point was this: with millions of people uninsured, millions of dollars and hours of physicians' time consumed by dealing with more than 1,300 health insurance companies, and the highest per-capita expenditure on health care—all without concomitant excellence in outcomes—we need to learn all the lessons we can from the health care systems of other countries.