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Fam Pract Manag. 2001;8(3):13-14

To the Editor:

Universal coverage for all Americans with a basic health plan is a laudable goal for the most part, but I have serious reservations about a couple tenets of the AAFP’s draft health care coverage proposal. [See the November/December 2000 Editor’s Page, “How Do You Like Your Universal Coverage?” page 11.]

Having all businesses contribute to the financing of the coverage certainly seems equitable but will most likely cripple many small and start-up businesses operating on thin profit margins. Also, the states are rapidly wasting tobacco-settlement money on various programs not related to health care with nary a whimper from organized medicine. Why should we expect this money to be used correctly?

Having worked in two health care systems that saw patients without co-pays, I know that utilization will increase if there are no co-pays. However, there should be some direct cost to the patient for a service provided; otherwise our time and skills mean nothing to them.

Finally, having worked directly with patients covered by the Oregon Health Plan, I can assure you that it has not lived up to its utopian ideal. It’s currently plagued with financial problems and has difficulty finding providers to take its patients. This will only worsen as medicine becomes more expensive and consumes a larger portion of each year’s state budget.


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