Sir

There is little question that the US health-care system requires reform. But it is debatable whether abdicating personal health-care decisions to an organization like the UK National Institute for Health and Clinical Excellence (NICE), as you recommend in your Editorials (Nature 461, 315–316 and 847; 2009), is the best approach to reform.

NICE decides “which of the available medical options is most effective at treating any given condition”. This is beyond reproach and deserving of the international accolades the organization has received. However, NICE also decides “which [medical option] is worth the money”. To many Americans, this is objectionable. It is a subjective assessment intimately tied to the individual and shouldn't be in the hands of a committee.

There are myriad reform schemes being debated that still preserve an individual's control over health-care decisions. A poorly implemented private care scheme can always be reformed, but choosing government control means there is no turning back.