Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.
Get full access to this article
View all access options for this article.
References
1.
StarrP.The Social Transformation of American Medicine. Basic Books, New York, 1982.
2.
AaronH. J.Serious and Unstable Condition. The Brookings Institution, Washington, D.C., 1991.
3.
PaulyM. V.A case for employer-enforced individual mandates. Health Aff. 13(2): 21–33, 1994.
4.
ReinhardtU. E.How to finance our changing health care system. Bull. N.Y. Acad. Med.63(1): 7–19, 1987.
5.
FuchsV. R.The Clinton Plan: A researcher examines reform. Health Aff. 13(1): 102–114, 1994.
6.
BodenheimerT.GrumbachK.Understanding Health Policy. Appleton and Lange, Stamford, Conn., 1995.
7.
HolahanJ.WinterbottomC.RajanS.A shifting picture of health insurance coverage. Health Aff. 14(4): 253–264, 1995.
8.
SchroederS. A.The medically uninsured—will they always be with us?N. Engl. J. Med.334: 1130–1133, 1996.
9.
HimmelsteinD. U.WoolhandlerS.WolfeS. M.The vanishing health care safety net: New data on uninsured Americans. Int. J. Health Serv. 22: 381–396, 1992.
10.
BrownE. R.Trends in health insurance coverage in California, 1989–1993. Health Aff. 15(1): 118–130, 1996.
11.
McLaughlinC. G.ZellersW. K.The shortcomings of voluntarism in the small-group insurance market. Health Aff. 11(2): 28–40, 1992.
12.
RennerC.NavarroV.Why is our population of uninsured and underinsured persons growing? The consequences of the “deindustrialization” of the United States. Int. J. Health Serv. 19: 433–439, 1989.
13.
MorriseyM. A.JensenG. A.MorlockR. J.Small employers and the health insurance market. Health Aff. 13(5): 149–161, 1994.
14.
OliverT. R.DowellE. B.Interest groups and reform: Lessons from California. Health Aff. 13(2): 123–141, 1994.
15.
DickA. W.Will employer mandates really work? Another look at Hawaii. Health Aff. 13(1): 343–349, 1994.
16.
ReinhardtU. E.Health insurance for the nation's poor. Health Aff. 6(1): 101–112, 1987.
17.
ReinhardtU. E.Are mandated benefits the answer?Health Manage. Q.10(1): 10–14, 1988.
18.
SmithA.An Inquiry into the Nature and Causes of the Wealth of Nations. Clarendon Press, Oxford, 1976.
MusgraveR. A.MusgraveP. B.Public Finance in Theory and Practice. McGraw Hill, New York, 1980.
21.
RasellE.BernsteinJ.TangK.The Impact of Health Care Financing on Family Budgets. Economic Policy Institute, Washington, D.C., 1993.
22.
PechmanJ. A.Who Paid the Taxes, 1966–85. The Brookings Institution, Washington, D.C., 1985.
23.
TerrisM.Determinants of health: A progressive political platform. J. Public Health Policy15(1): 5–12, 1994.
24.
SmeedingT.Inequality among children and elderly in ten modern nations: The United States in an international context. Am. Econ. Assoc. Proc.79: 321–324, 1989.
25.
Income disparity between poorest and richest rises. New York Times, June 20, 1996.
26.
U.S. House of Representatives. Committee on Ways and Means. 1991 Green Book. Washington, D.C., May 7, 1991.
27.
Rich control more of US wealth, study says, as debts grow for poor. New York Times, June 22, 1996.
28.
LevitK. R.CowanC. A.The burden of health care costs: Business, households, and governments. Health Care Financ. Rev.12(2): 127–137, 1990.
29.
LevitK. R.LazenbyH. C.SivarajanL.Health care spending in 1994: Slowest in decades. Health Aff. 15(2): 130–144, 1996.
30.
CantorJ. C.LongS. H.MarquisM. S.Private employment-based health insurance in ten states. Health Aff. 14(2): 199–211, 1995.
31.
CantorJ. C.Expanding health insurance coverage: Who will pay?J. Health Polit. Policy Law15: 755–778, 1990.
32.
HolahanJ.ZedlewskiS.Who pays for health care in the United States? Implications for health system reform. Inquiry29: 231–248, 1992.
33.
ReinhardtU. E.The Clinton Plan: A salute to American pluralism. Health Aff. 13(1): 161–178, 1994.
34.
DavisK.GoldM.MakucD.Access to health care for the poor: Does the gap remain?Annu. Rev. Public Health2: 159–182, 1981.
35.
RasellE.TangK.Paying for Health Care: Affordability and Equity in Proposals for Health Care Reform. Working Paper No. 111. Economic Policy Institute, Washington, D.C., 1994.
36.
Advisory Commission on Intergovernmental Relations. Significant Features of Fiscal Federalism. Washington, D.C., 1994.
37.
Tax Foundation. Tax Burden by Income Class, 1986–1987. Washington, D.C., 1989.
38.
PechmanJ. A.Federal Tax Policy. The Brookings Institution, Washington, D.C., 1987.
39.
MillerJ.GoodnoJ.Much ado about nothing. Dollars & Sense, December 1990.
40.
Special tax breaks enrich savings of many in the ranks of management. New York Times, October 13, 1996.
41.
Wealthy, helped by Wall St., find new ways to escape tax on profits. New York Times, December 1, 1996.
42.
AronsonJ. R.HilleyJ. L.Financing State and Local Governments. The Brookings Institution, Washington, D.C., 1986.
43.
Congressional Budget Office. The Changing Distribution of Federal Taxes: 1975–1990. Washington, D.C., 1987.
44.
Citizens for Tax Justice and The Institute on Taxation and Economic Policy. Who Pays? A Distributional Analysis of the Tax Systems in all 50 States. Washington, D.C., 1966.
45.
SomervilleJ.Public surveys draw opposite results on health reform. Am. Med. News, June 1, 1992.
46.
Greenberg-Lake. Health Care: The Pocketbook Issue of the Nineties. Washington, D.C., 1994.
47.
BlendonR. J.DonelanK.The public and the emerging debate over national health insurance. N Engl. J. Med.323: 2089–2112, 1990.
48.
BlendonR. J.The American public and the critical choices for health system reform. JAMA271: 1539–1544, 1994.
49.
JacobsL. R.ShapiroR. Y.Public opinion's tilt against private enterprise. Health Aff. 13(1): 285–298, 1994.
50.
SmithM. D.Taking the public's pulse on health system reform. Health Aff. 11(2): 125–133, 1992.
