Abstract
In Reply. —The letters by Drs Berger and Surman illustrate that queues for medical care elicit strong emotional reactions from physicians. While the clinical impact of queues on patients are unknown, the professional impact on physicians is clearer: external constraints limit the volume of services we can provide. The rapid growth of health care costs in this country provides little evidence that physicians can set limits. In response, every other country has controlled medical care costs through the imposition of global budgetary limits on health care spending. To the extent that these countries recognize that health care competes with other societal needs for scarce resources, this process is indeed socialized In Canada, a single payer provides a strong counterforce of fiscal restraint to the naturally expansive tendencies of fee-for-service medicine. At the interface of this political tension are rancorous public debates over limits on physician fees, expenditure caps, restrictions
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