This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Related letter  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Medical Practice, Other  • Quality of Care  • Quality of Care, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

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

To the Editor: In their Commentary, Drs Sessions and Lee¹ outlined the rationale for using tax reform to drive health care reform. While we agree with their call for a single program covering all US residents, and that the current fragmented system encourages health care institutions and physicians to shift costs, we disagree with their conclusion that the way forward is the creation of a voucher system to pay private insurers, financed by a regressive value-added tax (VAT).

First, a VAT would inflict a higher tax rate on the poor than the wealthy because the poor spend more of their income on consumer goods. For many poor Medicaid recipients who currently pay little or no federal taxes, a VAT would likely represent a severe financial hardship. Sessions and Lee state that this effect would be cushioned by adjusting other elements of the tax system, but they do not say how.

. . . [Full Text of this Article]

James S. Floyd, MD
jfloyd@citizen.org

Sidney M. Wolfe, MD
Health Research Group
Public Citizen
Washington, DC

Marcia Angell, MD
Harvard Medical School
Boston, Massachusetts

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Using Tax Reform to Drive Health Care Reform: Putting the Horse Before the Cart
Samuel Y. Sessions and Philip R. Lee
JAMA. 2008;300(16):1929-1931.
EXTRACT | FULL TEXT  

RELATED LETTER

The Role of Tax Reform in Health Care Reform—Reply
Samuel Y. Sessions and Philip R. Lee
JAMA. 2009;301(12):1226-1227.
EXTRACT | FULL TEXT