To the Editor: In their Commentary, Drs Sessions and Lee1 outlined the rationale for using tax reform to drive health care reform. While we agree with their call for a single program covering all US residents, and that the current fragmented system encourages health care institutions and physicians to shift costs, we disagree with their conclusion that the way forward is the creation of a voucher system to pay private insurers, financed by a regressive value-added tax (VAT).
First, a VAT would inflict a higher tax rate on the poor than the wealthy because the poor spend more of their income on consumer goods. For many poor Medicaid recipients who currently pay little or no federal taxes, a VAT would likely represent a severe financial hardship. Sessions and Lee state that this effect would be cushioned by adjusting other elements of the tax system, but they do not say how.
Second, by retaining private insurers they ensure the continuation of bureaucratic waste, preventing cost containment. Overhead of private insurers has averaged 12%—compared with 3% for Medicare—and total administrative costs have accounted for more than 30% of health care spending.2
Third, Sessions and Lee assert that competition among private insurers would lead to improved quality and satisfaction. This flawed argument can be used to justify the current failed system, which encourages for-profit care and treats health care as a commodity to be purchased in an imaginary free market. Rather, a growing body of evidence indicates that for-profit institutions deliver inferior care at inflated prices.3 Moreover, experience with private Medicare health maintenance organization programs indicates that insurers will mainly compete for healthy patients while discouraging the enrollment of those with costly and unprofitable illnesses.4
We believe that only the elimination of private health insurance and the creation of a single, national health insurance plan covering everyone can simultaneously address the problems of cost, quality, and access. The authors' claim that “proponents of single-payer plans . . . seldom provide much detail [on what taxes should be increased]” is incorrect; a 2003 JAMA article outlined a plan of progressive taxation to fund a national health insurance plan.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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