Lewis Mehl-Madrona: More about Single Payer In this article, I continue my musings about single-payer health systems. I share my experiences of working within the Canadian health care system as a physician (family medicine and psychiatry). I describe the back logs we did have and how we got around them, the lack of utilization review, how I could hospitalize anyone at anytime so long as there was a bed open, and how no one pushed me to discharge patients too early.

Lewis Mehl-Madrona: Clinic Restructuring I work part-time in a community mental health center in New York. Recently New York's Office of Mental Health has restructured clinical services. I write about what that has meant for quality of care, which inevitably goes down. I argue that this is inevitable in a "fee-for-service" system. I argue that the alternative is to pay physicians to care for panels of people and to do the best job as they see fit for these people.