Bodenheimer T, Sullivan K
Int J Health Serv. 1997;27(3):409-25. doi: 10.2190/YAGR-4KXN-J50E-B62H.
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.
基于就业的医疗保险面临严重问题。首次出现，受此类医疗保险覆盖的美国人数量正在下降。雇主强烈反对通过雇主强制参保的方式来扩大医疗保险覆盖范围。基于就业的筹资方式既具有累退性又复杂。需要就为所有美国人提供医疗保健筹资的替代解决方案展开严肃辩论。税收是基于就业的医疗保健筹资的一个明确替代方案。选择税种的主要标准是公平，其次是简单性。专项的累进个人所得税是一种公平且可能简单的为医疗保健筹资的税种。这种税在政治上的可行性大于雇主强制参保立法。
