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State Governments, Taxes Key to Health Care Reform

Greater governmental cooperation and value-added tax are needed, commentary authors urge

TUESDAY, Oct. 21 (HealthDay News) -- Two actions that would strongly promote U.S. health care reform are greater cooperation between federal and state governments and a value-added tax to cover universal health insurance vouchers, according to two commentaries published in the Oct. 22/29 issue of the Journal of the American Medical Association.

In one, Ezekiel Emanuel, M.D., Ph.D., of the National Institutes of Health and Senator Ron Wyden, J.D., write that states offer ideal settings for experimenting with reform ideas, but they face limits on authority and resources, and can't control most of the major forces influencing U.S. health care. The authors suggest that states should take on roles including creating insurance exchanges, prohibiting insurance plans from discriminating against those with pre-existing illnesses, and being innovators on programs targeting their citizens' particular needs.

In the other commentary, Samuel Y. Sessions, M.D., J.D., of the Harbor-UCLA Medical Center in Torrance, Calif., and Philip R. Lee, M.D., of the University of California San Francisco, write that 60 percent of U.S. health care costs are financed by taxes. Comprehensive tax reform could make this process more deliberate and transparent, they suggest. With a value-added tax covering universal vouchers, Medicaid and Medicare could be phased out and a large amount of existing taxes could be eliminated, they write.

"Many liberals support health care reform proposals that increase both taxes and health care regulation, giving conservatives two reasons not to support them. The plan described could appeal to conservatives by relying on increased competition to reform health care and to liberals by virtue of more stable and potentially more equitable taxes. A less regulatory approach to changing health care would be exchanged for more transparent taxes," Sessions and Lee write.

Abstract - Emanuel
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Abstract - Sessions
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