Abstract
The health system in the United States today is in need of serious reform. Several suggestions offered are utopian, not in the sense that they are wildly unrealistic, impossible to implement, or exorbitantly expensive but, rather, in that they envision restructuring the health system on the basis of reason and rationality without regard to what is already in place. Most of these proposals have already been attempted in other countries or have been employed at the state level in the United States. This article suggests that if the federal government were to play a greater role, health care costs might be contained and access might be broadened. Coordination of care and patient participation could improve health system performance. The United States might learn something from the single payer system and global hospital budgets. It may be necessary to increase the proportion of general practitioners, require local cooperation between hospitals, restructure the legal system relating to malpractice claims, and adopt a long-term accounting focus for health economics. As cost-containment features are developed, quality of care needs to be maintained and enhanced simultaneously. Evidence from the Canadian case is offered throughout.