US health care needs higher taxes and rationing
http://www.100md.com
《英国医生杂志》
Higher taxes and possibly eventual limiting or rationing of services are inevitable if US citizens are to get universal health care. And healthcare professionals should lead the way in helping the public confront this unpleasant truth, say James Mongan and Thomas Lee in the New England Journal of Medicine (2005;352:1260-3).
Their article says that the recent US election might have considered whether broader health coverage should be a high priority. The anti-tax movement should, they say, be recognised as the "main enemy of those who truly seek to meet the needs of the 45 million uninsured Americans."
A linked editorial recommends that the government should become more involved in influencing how the money is spent (p 1252-5). Richard Kronick warns of the limitations of the present system of health care in the United States: "Under the status quo, expenditures are increasing at a rate that is unaffordable, many resources are used in clinical and administrative activities that do little to improve health, and accountability mechanisms are weak. As messy and difficult as a publicly financed system is likely to be, the alternatives are worse.
"We do know how to ensure universal coverage, but we do not know how to ensure that our money will be spent well. We should not let uncertainty about how best to spend money prevent us from supporting proposals for universal coverage in the context of a system that would be less chaotic and more affordable."
The editorial describes a second article as offering a thought provoking suggestion for moving toward universal health care (p 1255-60). Ezekiel Emanuel and Victor Fuchs propose a voucher system financed by a value added tax that would balance the public抯 demand for additional services with voters?willingness to support a tax increase.
The authors "recognise that change is not imminent" but think that their proposal "can stimulate discussion and provide a readily available model when the political climate becomes hospitable for endorsing meaningful reform."
Their plan would give vouchers to guarantee and pay for basic health services from a qualified insurance company or health plan to every American younger than 65 years of age, regardless of the patient抯 medical history.
The earmarked value added tax could ensure a direct link between benefit levels and level of taxation so that if people wanted more services to be covered in the basic plan, they would have to be willing to support a tax increase. The voucher system could guarantee Americans universal coverage for the first time, without means testing or exclusion for existing medical conditions.(Quebec David Spurgeon)
Their article says that the recent US election might have considered whether broader health coverage should be a high priority. The anti-tax movement should, they say, be recognised as the "main enemy of those who truly seek to meet the needs of the 45 million uninsured Americans."
A linked editorial recommends that the government should become more involved in influencing how the money is spent (p 1252-5). Richard Kronick warns of the limitations of the present system of health care in the United States: "Under the status quo, expenditures are increasing at a rate that is unaffordable, many resources are used in clinical and administrative activities that do little to improve health, and accountability mechanisms are weak. As messy and difficult as a publicly financed system is likely to be, the alternatives are worse.
"We do know how to ensure universal coverage, but we do not know how to ensure that our money will be spent well. We should not let uncertainty about how best to spend money prevent us from supporting proposals for universal coverage in the context of a system that would be less chaotic and more affordable."
The editorial describes a second article as offering a thought provoking suggestion for moving toward universal health care (p 1255-60). Ezekiel Emanuel and Victor Fuchs propose a voucher system financed by a value added tax that would balance the public抯 demand for additional services with voters?willingness to support a tax increase.
The authors "recognise that change is not imminent" but think that their proposal "can stimulate discussion and provide a readily available model when the political climate becomes hospitable for endorsing meaningful reform."
Their plan would give vouchers to guarantee and pay for basic health services from a qualified insurance company or health plan to every American younger than 65 years of age, regardless of the patient抯 medical history.
The earmarked value added tax could ensure a direct link between benefit levels and level of taxation so that if people wanted more services to be covered in the basic plan, they would have to be willing to support a tax increase. The voucher system could guarantee Americans universal coverage for the first time, without means testing or exclusion for existing medical conditions.(Quebec David Spurgeon)