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December 7, 1994

The Medical Bank Account: Another Look at Health System Reform

Author Affiliations

Framingham, Mass

JAMA. 1994;272(21):1657. doi:10.1001/jama.1994.03520210041021

To the Editor.  —I present the following proposal for restructuring health insurance that could allow for decreased costs, increased choice, and minimal increase in government bureaucracy and builds on documented effective programs.1,2

  1. A package of mandated health care benefits is decided on, including both preventive and catastrophic care, to be provided by private insurance companies.

  2. Every American would be required to purchase such insurance, either directly or through their employer.

  3. There would be no exclusion for preexisting conditions, with community rating based on the national sample.

  4. Each policy would have an optional deductible.

  5. Each individual adult (or family) would have a medical bank account to which they and/or their employers could make tax-free contributions. This medical bank account would accumulate interest tax free and, prior to Medicare eligibility, could be used only to pay for health care expenses for the adult and his or her dependent children up to

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