Tax Proposal Ignores Scope of Problems

Columnist James Flanigan’s suggestion for a new tax on health providers to finance health care for the uninsured (“Health Care Crisis Could be Solved by--Yes--a New Tax,” Sept. 20) ignores the mammoth scope of our country’s problems.

There are 2.6 million people in Los Angeles County who do not have health insurance. That’s roughly 10 times as many as in all of Minnesota, the state Flanigan holds up as a model for a provider tax. A 2% tax on the gross revenue of providers would not pay for the health care of our huge number of uninsured.

Moreover, the tax would financially sink many providers because their fees are frozen by the contracts they have signed with managed-care plans and they could not pass the cost on. The tax would also hit local private hospitals hard. Many of them are teetering on the brink of insolvency.

Contracting out health care to the private sector or public-private partnerships may save some money through improved efficiency, but the country’s clinics and hospitals are not as inefficient as Flanigan believes. They have been caring for an ever increasing number of patients with shrinking resources for several years now.

Perhaps Flanigan should explore why the numbers of the uninsured continue to increase even though the cost of insurance, due to intense competition among the managed-care insurance behemoths, has stabilized or even dropped. The bulk of Los Angeles County’s 2.6 million uninsured are workers or the dependents of workers. Until we start to reduce this number, no solution to our county’s health and finance problem is likely to succeed.

VINCENT GUALTIERI, MD

President

Los Angeles County Medical Assn.

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As a provider, I already do my share of helping people without insurance and thus could not comprehend why providers should be the one to solve this societal problem. By the same analogy, I suppose you think supermarkets and grocery store employees should be taxed to feed the hungry, that contractors and construction workers should be taxed to house the homeless and that The Times and its writers should be taxed to pay for people who cannot afford the paper.

Just because I am in the health care “business” (and I truly realize it is more than a business) should not mean that I and others already helping people should pay whatever society’s debt is to those in need.

You implied that the costs for others would be raised in an equal amount to pay for this tax, but that would not happen. For example, the federal government will not raise payments locally in Los Angeles to providers just because that one area is taxing the people taking care of the patients.

It is a real, very difficult problem and I do not pretend to know the “answer,” but placing the burden on the backs of the people and organizations already taking care of the sick is not the one.

There is a good deal of waste and over-treatment in our society, but even if all that was eliminated, I am not sure the costs could still be covered, because again, to use an analogy, it’s as if when one was hungry you tell the person to go to the supermarket and get whatever he “needs” with basically no limit, or tell a homeless person to pick out whatever housing he wants.

If we did that, those systems would also be more in debt. Until society changes its attitude about what constitutes standard medical care in this country, this will be a very difficult problem to solve.

IAN BRESSLER, MD

Culver City

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Mr. Flanigan’s proposed “provider tax” to solve the problem of financing health care of the medically indigent is a simple but totally unreasonable solution. Suggesting that “users of the medical system will pay through increased fees” shows his total lack of knowledge of the “cost-containment” strategies in health care management.

Once again the burden of cost will fall on the providers who already are underwriting the discounted services offered to managed-care entities.

No, Mr. Flanigan, we providers cannot single-handedly be responsible for the public health impact or prevention of communicable diseases of the medically indigent. The health care crisis is the responsibility of every citizen and must be shared equally.

MARY LOU OZOHAN, MD

Tarzana