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October 22 2008

Using Tax Reform to Drive Health Care Reform: Putting the Horse Before the Cart

Author Affiliations

Author Affiliations: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Dr Sessions); and School of Medicine, University of California, San Francisco (Dr Lee). Dr Sessions is now with the Department of Psychiatry and Biobehavioral Sciences, and LABiomed, Harbor-UCLA Medical Center, Torrance, California.

JAMA. 2008;300(16):1929-1931. doi:10.1001/jama.2008.512

Incremental change and policy making by inaction have left US health care finance in disarray. Aaron1 has called existing health care finance arrangements “an administrative monstrosity, a truly bizarre mélange of thousands of payers with payment systems that differ for no socially beneficial reason.” The ever-growing roster of health care funding sources now includes employer-paid and employee-paid insurance premiums; patient co-pays and deductibles; federal and state income and payroll tax subsidies; the itemized deduction for medical expenses; tax subsidies for health savings accounts, Archer medical savings accounts and section 125 “cafeteria” plans; the Medicare Part A payroll tax; Medicare Part A, B, C, and D premiums; and federal, state, and local general revenues.2,3 Even this is only a partial list.