A tax reform strategy to deal with the uninsured

Article Abstract:

There is general agreement that the nation's health care system needs to be reorganized so that all Americans will be covered by health insurance. Many of the problems with the current system were caused by strong and counterproductive incentives built into the tax code with regard to health care. A system based on consumer-driven markets can correct these deficiencies. Employer-based health insurance is a major cause of lack of insurance and escalating health care costs for three reasons. First, the income tax exclusion benefit of untaxed insurance is regressive, worth more to those with higher incomes. Second, it limits job mobility because changes mean waiting periods and no coverage for preexisting conditions. Third, there is no reason for an employee to choose lower cost health care, and physicians and hospitals have no incentive to hold down costs. Inflationary pressures force companies to reduce coverage. The Heritage Foundation's proposal for tax reform would change the structure of tax relief, and provide a more progressive system of help for those who need it. It would also provide incentives for consumers to seek lower cost care and the best insurance value. The current tax exclusion would be replaced by a system of refundable tax credits for health expenses, and all heads of household would be required by law to enroll all family members in a basic health plan. Those who cannot afford to enroll would have government help. The proposed changes in taxation are discussed. This is a less radical proposal than installing a system like that of Canada, and it can be advanced slowly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Taxation, Statistics, Medical care, Cost of, Health care costs

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Let's provide primary care to all uninsured Americans - now!

Article Abstract:

A problem of national significance is the lack of health insurance of over 30 million Americans. Much debate exists over the solution to this problem; at least one reason a consensus cannot be reached is that most arguments assume that universal health coverage must provide comprehensive coverage of all medical problems. Providing some form of coverage for primary care medicine would be a means of bridging the gap between no insurance and comprehensive coverage. Studies have shown that providing free primary care services results in better vision, greater control of high blood pressure, better dental health, more complete immunization, and decreased mortality. Increased primary care coverage need not be exorbitant. One estimate is that primary care services could be provided to all Americans for 15 to 20 percent of the current national expenditure on health care. To keep the costs of providing this primary care reasonable, a change from fee-for-service to prepaid health plans would be necessary. Given that the number of graduating medical students electing to enter primary care specialties has been decreasing in recent years, guaranteeing a set salary might attract more students to these fields. Removing the tax-exempt status of employer contributions to health care benefits might generate adequate income to pay for these increased primary care services. (Consumer Summary produced by Reliance Medical Information, Inc.)

Planning, Reports, Demographic aspects, editorial

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Physician utilization disparities between the uninsured and insured: comparisons of the chronically ill, acutely ill, and well nonelderly populations

Article Abstract:

Non-elderly individuals with health insurance may be more likely to receive adequate medical care than are those without health insurance. Between 31 and 37 million individuals in the US do not have health insurance, and these numbers are increasing. A study compared use of health care services over a 12-month period by individuals under 65 years old with and without health insurance. Individuals with health insurance were more likely to have visited a physician over the 12-month period. Among individuals with good health and those suffering from a chronic illness, those with health insurance were twice as likely to have visited a physician as those without medical insurance. While all those who were acutely ill were more likely to seek care, those with insurance were still almost one-third more likely to have visited a physician than were uninsured acutely ill persons.

Health aspects, Care and treatment, Economic aspects, Medical care, Health insurance, Physician services utilization

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