Public financing central to solving problem of the uninsured

LETTER — Posted July 19, 2004

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Regarding "Tax credits are best approach for uninsured" (Editorial, June 14): I must disagree. If we are to be compensating for caring for the uninsured, organized medicine must abandon its love affair with tax credits and private commercial insurance. There is a reason insurers don't currently compete to offer coverage to individuals and small businesses. The insurers know that a small percentage of people (the sick) are responsible for a large percentage of the cost.

The easiest way to make money in the insurance business is to cover large groups of healthy people, and find and exclude the high risks, the sick. This is called underwriting, or risk management. It denies coverage to the very people who need it most. Consider our experience with the portability provisions of HIPAA: Certainly a laid-off employee can continue to participate in his or her former employer's health plan, but often only with a big premium hike. Regulations won't solve the problem either. If government mandates premiums that are too low to cover the cost of care, companies may simply withdraw from the market (think Medicare+Choice, or malpractice insurance.)

The only way we can cover the uninsured -- the working poor and the sick -- is to provide public financing in some way, whether government re-insurance a la Kerry, pay-or-play, or the opportunity to buy into Medicare.

Caroline Poplin, MD, Bethesda, Md.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/07/19/edlt0719.htm.

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