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October 16, 1991

Caring for the Uninsured and Underinsured

Author Affiliations

Governor State of Vermont Montpelier

Governor State of Vermont Montpelier

JAMA. 1991;266(15):2080. doi:10.1001/jama.1991.03470150050023

To the Editor.  —You are to be congratulated for your outstanding edition on universal health insurance (May 15, 1991). It was well-organized and well thought out, and I deeply appreciate your attention to this topic. As one of the few politicians in this country who practices medicine, I'd like to share the following observations.There are two major faults with many of these plans. The first is that a number of them rely on continuation of the Medicare program. Any practicing physician will tell you that the Medicare program is a disaster. It underreimburses the physicians, it undercompensates the insured patients, and its bureaucracy and interference with medical practice are demoralizing.Second, the major shortcoming of many plans (including that of the American Medical Association) is the lack of serious provision for cost containment. That also applies to the Pepper Commission and many of the other plans that rely on