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In Reply: Dr Floyd and colleagues raise important questions about our proposal to assign taxes a central role in health care reform, rather than view them merely as a source of revenue. We argued that the antiquated tax structure now funding health care badly needs an overhaul, and we advocated a plan to finance universal health insurance vouchers with a VAT. This would convert the fragmented confederation of health care subgroups into a unified system covering everyone, young and old, employed or not.

They note correctly that a VAT, a form of sales tax, is in principle regressive, imposing a heavier burden on low-income than high-income families. We are aware that this is only partly ameliorated by the health insurance the former would receive and that a VAT by itself could reduce low-income families' disposable income far too much. We pointed out that adjustments to other elements of the tax . . . [Full Text of this Article]

Samuel Y. Sessions, MD, JD
ssessions@mednet.ucla.edu
Department of Psychiatry and Biobehavioral Science
Harbor-UCLA Medical Center
Torrance, California

Philip R. Lee, MD
School of Medicine
University of California, San Francisco

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RELATED LETTER

The Role of Tax Reform in Health Care Reform
James S. Floyd, Sidney M. Wolfe, and Marcia Angell
JAMA. 2009;301(12):1226.
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