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April 5, 1995

Health System Reform: Still Twitching

Author Affiliations

St Petersburg, Fla

JAMA. 1995;273(13):997. doi:10.1001/jama.1995.03520370037024

To the Editor.  —Dr Schiff and colleagues1 are correct in that perhaps an 8% to 10% addition on our income tax rates would bring sufficient financing for national health care of basic universal coverage. This would be in addition to a coinsurance factor on outpatient services of anywhere from 15% to 30% based on annual income as well, and with inpatient services having a 5% to 15% coinsurance factor, without deductible.After folding Medicaid, Medicare, and the Veterans Affairs hospitals into this system, the total take will approach $800 billion. The federal government should collect the money as a payroll tax and take it off budget and dole it out to the states based on population and age with the states administering the program.We cannot expect to get more out of the system than we put into it. Some fine-tuning in terms of adjustable rates for the coinsurance

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