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Putting the Horse Before the Cart

Samuel Y. Sessions, MD, JD; Philip R. Lee, MD

JAMA. 2008;300(16):1929-1931.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

Directly and indirectly, tax financing now covers more than 60% of US health care costs.⁴ In the abstract, it is possible . . . [Full Text of this Article]

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.

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