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.
Sessions SY, Lee PR. Using Tax Reform to Drive Health Care ReformPutting the Horse Before the Cart. JAMA. 2008;300(16):1929–1931. doi:10.1001/jama.2008.512
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