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September 8, 2004

The AMA Health Insurance Proposal

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(10):1173. doi:10.1001/jama.292.10.1173-a

To the Editor: The article by Dr Palmisano and colleagues1 on expanding insurance through tax credits appears to be an attempt to save a sinking ship by finding more buckets instead of doing something to hold back the water. Specifically, the authors state that "the Achilles heel of individual insurance markets has been adverse selection." However, when asked, consumers respond that the "Achilles heel" of their insurance is the high cost of deductibles and the co-payment provisions2 as well as the high premium cost. Even with good insurance coverage, the average family can pay thousands of dollars annually in out-of-pocket medical expenses before the insurance coverage kicks in. Add to that the co-payment for a major illness, and the average family can easily face financial ruin.