In Reply.—We agree with Hess that a single-payer health insurance system would increase access to care. In fact, in our letter we stated that "one of the solutions [to the access problem for children] is to increase the percentage of Americans with health insurance." Our response to Hess' contention that a single-payer system will increase access to care for everyone is this: access to what kind of care? If care is not available in the community in which patients live, or it is provided by employees and physicians who do not speak the patient's or family's language and who do not understand their cultural background, or it is provided in an office in which racial and ethnic diversity is not respected, we question the value of that care or whether care will be received.
The point of our letter was that in addition to universal health insurance, we need to create