In the August 15 issue, APA President Nada Stotland, M.D., concluded her column by describing her visit to the Royal College of Psychiatrists' annual conference with the comment, "While there is some interest in privatization, most people are satisfied with the current system," and she noted that "over the past 10 years, the NHS [National Health Service] has greatly reduced waiting times and introduced standards... and is moving in the direction of increased patient choice."

These comments combine a quite remarkable and very unfortunate distortion of the true situation with a failure to understand and realize why the positive elements are almost entirely a product of the element that Dr. Stotland chose to minimize.

The real situation is that there is a very large private health care system in Great Britain, with leading private hospitals, clinics, and physicians providing care to large numbers of people who pay for that care through insurance offered by a few private companies. The enormous growth in the private alternative dates from the time when Margaret Thatcher was prime minister.

It is the presence of this private alternative that has provoked the NHS to make whatever small improvements it has made in the past few years. It is a response to public demands and the comparisons that citizens were making between the quality of service and rapid access that the private alternatives offered and the huge deficiencies that were notorious and chronic in the NHS.

The NHS or public system most definitely offers medical help to anyone. At times the standards may indeed be high, and no sensible voices are suggesting that it be abandoned. But in Great Britain many people know that in the private system they may receive care that they would not receive in the public system, and in the circles of my relatives and friends in Great Britain, all of them have private insurance and at times make crucial and vital use of the private system.