As a former Canadian with many contacts still there, I would strongly advise against a single-payer system (“Health care debate: Do psychiatrists support the public option?” From the Editor, Current Psychiatry, November 2009). It will not solve our health care problems; in fact, many of our patients will be worse off than now.
The lack of choices for both the patient and doctor when the government makes therapeutic choices can lead to a situation where psychotherapy almost disappears from psychiatry. In the United States we are struggling with managed care and its disincentives for psychotherapy in psychiatry, but at least patients can choose a psychiatrist who uses a combined approach.
Norman Straker, MD
Clinical professor of psychiatry
Weil Cornell Medical College
New York, NY