Paul Cary makes several important and worthwhile points. However, in discussing why the British spend one-third less on health care than Canadians, he suggests that “health care policy planners in Canada have felt that savings of this magnitude have been achieved in Britain by the panacea of capitation and salary as the payment options for physicians.” Serious analysis of the health care system in Canada has never suggested this, nor is it likely to. The work of the National Forum on Health and recent reports from Quebec and Saskatchewan all point to some form of primary care reform and diversification of physician compensation methods. This diversification has been advocated in every serious reform effort in Canada to allow greater flexibility and accessibility in the organization of health services, not simply to save money. I agree with Cary that the health care system of the United Kingdom will remain challenged for the foreseeable future. The market requires that the public system be continuously portrayed as second rate in the UK to make a private tier appealing. I am afraid that no amount of reform talk will change this reality.