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June 3, 1998

Universal Health Insurance

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(21):1700-1701. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-21-jbk0603

To the Editor.—Despite the reluctance of the United States to consider universal, national health insurance, as Dr Ginzberg1 points out, in response to the increasing costs of health care, people may be forced to seek governmental intervention in the form of a federal-state health program.

Although there is widespread fear of a government takeover of the health care system, Medicare and Medicaid, which represent national health insurance for more than 70 million Americans,2 are reasonably effective. Without exorbitant profits, without penalizing patients for preexisting conditions, and without using financial incentives to control physician behavior, these programs provide care for more than 25% of the poorest, oldest, and sickest members of the society. Concentrating on taking care of the most needy patients and not on profits for shareholders is more in line with a sense of equality. Unlike other items, such as vacations, new cars, or new homes, basic health care is something to which most people feel entitled regardless of their ability to pay. It is impossible to have such a system if the primary goal is to generate profits, which has been demonstrated by a managed care system.

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