American Medical News
January 21, 2002
Opinion
“The time is right to fix the problem of the uninsured” by Richard F. Corlin, M.D., President of the American Medical Association
“Let’s quickly summarize our AMA proposal:
“We endorse the concept that employers provide a defined contribution for the purchase of health expense coverage — rather than a defined benefit.
“Our proposal supports a system in which all Americans with health coverage are given tax credits — in amounts inversely correlated with their income — rather than excluding employer-provided health benefits from their taxable income.
“We also support the creation of opportunities for alternative health insurance markets — “voluntary choice cooperatives” — that would offer more choices for individuals than are presently available.
“Universally available medical savings accounts play an important role in this consumer-oriented system.”
“And the AMA plan would also help to develop in each and every individual a consciousness of the real costs involved in their health care choices.”
“Let me know what you think about our plan.”
Comment: Briefly, the impact of the AMA proposals:
Defined contribution – Results in under-funding of comprehensive coverage, leaving low-moderate and low income individuals with Spartan benefits and greater out-of-pocket expenses, impairing access to care because of lack of affordability
Tax credits – Result in severe under-funding of comprehensive coverage with the same consequences as defined contributions, and threatens the link of health insurance to employment, increasing the numbers of uninsured
Alternative health insurance markets – Creates multi-tiered health care by creating a marketplace for the Spartan plans that a defined contribution or tax credit could purchase, while opening access to all products for the affluent
Medical Savings Accounts – Removes funds from the risk pools for the sick and poor making the Spartan products even less affordable
The AMA proposal is a disaster for those with modest or low incomes. The proposal shifts too much of the responsibility of paying for care to the individuals who have the greatest medical needs. This defeats the fundamental purpose of health insurance, and that is to pool risk, providing security for everyone by shifting the costs of paying for care from the large numbers of healthy individuals to the smaller numbers of those with greater needs. Under the AMA proposal, the affluent can self-fund the deficits, assuring their own security, but modest income individuals will not be able to bear the burden of the costs of major medical problems.
Why would the AMA support such a cruel proposal? Two considerations come to mind. Physicians wish to escape from the restrictions on fees and services that have been characteristic of the age of managed care. Many physicians believe that the AMA proposals will remove constraints on their fees and services. They are content to care for more affluent patients, whereas those that cannot afford their services can be someone else’s problem. Thus the proposal is very self-serving for physicians. The other reason that we can speculate is that the AMA leadership is saturated with political conservatives that ideologically prefer the wealth-oriented policies of the Heritage Foundation (
Most physicians really do care about patients. Please honor Dr. Corlin’s request to let him know what you think about the AMA plan. His e-mail address is above.