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To the Editor: The American Medical Association's (AMA's) proposal for reform of the American health care financing system¹ fails to account for the fact that, for an essential product like basic health care services, insurance must be universal and mandatory. Otherwise, adverse selection occurs, leaving patients at risk of no access when they need it most. Besides, only 100% enrollment makes coverage affordable and efficient, as demonstrated by the only US universal health insurance program, Medicare. The option to choose among various health insurance products is of little value to consumers. It might be better to offer a uniform basic health plan package with options for nonessential enhancements that might be added at individuals' discretion.

Ole J. Thienhaus, MD, MBA
thien_o@unr.edu
School of Medicine
University of Nevada
Las Vegas

1. Palmisano DJ, Emmons DW, Wozniak GD. Expanding insurance coverage through tax credits, consumer choice, and market enhancements: the American Medical Association proposal for health insurance reform. JAMA. 2004;291:2237-2242. FREE FULL TEXT

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

JAMA. 2004;292:1173.

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