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October 16, 1991

Caring for the Uninsured and Underinsured-Reply

Author Affiliations

Physicians for a National Health Program Cambridge, Mass

Physicians for a National Health Program Cambridge, Mass

JAMA. 1991;266(15):2079. doi:10.1001/jama.1991.03470150050020

In Reply.  —Dr Schweppe articulates many of the advantages of the single-payer approach to health insurance that is a critical feature of the Physicians for a National Health Program proposal. As to the question, "How are we going to pay for it?," we have stressed the principle of relying on "healthy" financing mechanisms—progressive payments and taxes on unhealthy products, such as cigarettes. Although we suggested a greater role for payroll taxes in order to minimize disruption of the existing pattern of funding, a graduated federal tax such as that proposed by Schweppe would certainly be consistent with our financing principles. In contrast, employer-mandate proposals violate the "healthy" financing principle by imposing an extremely regressive tax on employers and employees in low-wage businesses in the form of mandatory private insurance premium payments that are not adjusted for income.Schweppe correctly emphasizes the administrative savings possible under a single-payer system. Since the