AMA outlines plan for insurance coverage expansion

The American Medical Association outlined its plan for expanding insurance coverage to approximately 95 percent of Americans in a "Special Communication," published in the Journal of the American Medical Association, published the week of May 11.

"There is no question that we must find a solution to the problem of the more than 43.6 million people who are uninsured in this country," said AMA President Dr. Donald J. Palmisano in an AMA news release. "Research shows that the health consequences for Americans without insurance can be devastating. The AMA advocates a solution to the uninsured crisis that builds on the strengths of our current system.

We believe that a health care system based on a mix of private and public sector financing will best benefit the uninsured, improve quality, restrain costs, and expand patient choice and individual purchasing power."

The plan calls for a comprehensive three-pronged program to include:

Tax credits for the purchase of insurance. The current federal income tax exclusion system provides the greatest benefits to the wealthiest employed persons and their families. Those that do not have employer-based coverage and those in the lowest tax brackets receive little or no tax benefit. The AMA plan would replace the current tax exclusion of employer-based health insurance with tax credits that are inversely related to income (and large enough to ensure that health insurance is affordable for most people), refundable and advanceable.

Advanceable credits would mean that people do not need to wait until their federal income taxes are filed to use the credits to purchase insurance. Employers' spending on employee health benefits would remain fully deductible as a business expense.

Individually selected and owned health insurance. Under the AMA proposal, an employer's option of health plans would no longer be the only group coverage option for people. Individuals would be able to choose coverage that reflects their personal health care preferences and needs. In the current system, employees often cannot change insurance carriers if they are unhappy with their service or coverage. Providing a choice of plans will allow individuals to be more satisfied and increase access to care.

Expansion and formation of new insurance markets. The AMA plan would increase choice in the individual and group health insurance markets by implementing insurance market reforms and incentives to offer a wider range of new, affordable and permanent insurance options. The expansion of managed care has led to the current system, which the AMA said has limited individual choice and damaged the patient-physician relationship often resulting in patients deferring care.

"The AMA's proposal would give people the power to choose their health plan and give patients and their physicians what they want and deserve more control over their health care decisions," Palmisano said.

The "Special Communication," authored by Palmisano and David Emmons, PhD, and Greg Wozniak, PhD, AMA's Center for Health Policy Research, also warns against the dangers of implementing a single-payer, government-run system. The AMA previously has noted that by implementing a single-payer system, the United States would be trading the uninsured problem for an entire new set of other problems that may be much worse.

Long waits for health care services, a slowness to adopt new technologies and maintain facilities, and development of a large bureaucracy that can cause a decline in the authority of patients and their physicians over clinical decision-making are all hallmarks of the single-payer system, according to the AMA.

"The AMA has learned from countries that have a single-payer system, that the solution to the health care problem is a mix of private and public sector financing, with coverage and care remaining in the private sector," Palmisano said.