Sunday, October 12, 2008

Ruth Marcus ["Whose Health Plan?", op-ed, Oct. 7] is correct that eliminating the tax preference for employer-sponsored health insurance, as proposed by Republican presidential nominee John McCain, could bring greater rationality to tax policy. Current tax policy on health insurance favors those who have the highest incomes and those who receive the most generous benefits from their employers.

Mr. McCain's strategy would be an ingenious way to fund expansions in coverage through a progressive taxing scheme, were it not for reverberations that would be felt in the employer health insurance market, which experts agree would push tens of millions of people into the individual market.

In the individual market, administrative costs as a share of premiums are more than 20 percent higher than costs in employer-group markets and in public plans. So much for greater efficiency. Moreover, premiums in the individual market vary by health status, age and geographic location -- three factors on which the McCain plan's tax credits would not vary.

The result would certainly be that more people who are sick or are getting up in years or who live in high-cost areas such as Washington would not have health insurance.

LISA DUBAY

Director of Policy Studies

Department of Health Policy and Management

Johns Hopkins Bloomberg

School of Public Health

Baltimore