When employees think of changing jobs, they also must consider changing healthcare benefits. When they lose their jobs, they often lose their benefits. This is the portability problem of American medicine, and it obviously occurs because employers pay their workers' healthcare.
Most healthcare reform plans before Congress attack this problem through insurance reform. But that doesn't address the underlying problem of tax incentives that favor medical care paid by employers over patient-paid care.
Taxes serve two purposes: The first is to raise revenues. The second, more obscure, purpose is to achieve economic and social goals. For instance, let's imagine that a powerful congress member from Illinois wanted to create jobs for the state and succeeded in passing a law that allowed the purchase of all cars built in Illinois to qualify for a deduction from the purchaser's income taxes. If we could go 50 years into the future, we would see that people would more likely than not be buying cars made in Chicago than in Detroit.
Make all medical care 100% tax deductible and within months the portability problem will begin to melt away. The rationing problems of managed care also would melt away as people became connected to the cost of their own medical bills and began to value shop by looking at cost and quality. As a physician, I could then know who my customer was: the patient I care for or the employer that pays me through an insurance company.
BERT A. LOFTMAN, M.D.