By Jean-Pierre Forage, M.D., F.A.C.S. Much political hay has been made over the fact that 45 to 50 million Americans are without health insurance.  Little recognition is given to the fact that care was provided to these patients without compensation. While it seems to be politically popular to call for healthcare reform and find new ways to pay for this in the form of new taxes and restructuring government, one fact remains:  patients in this country have always been cared for by physicians with or without payment.  In this current economic crisis I would submit to you that we continue to allow providers to care for patients without the government compensating them, rather than generating some new type of Medicaid for the masses or fully a subsidized health care plan. I would suggest that we leave the current system in place, with the following provisos: 1) Physicians continue to care for patients as they have, and all patients below a certain income level would be treated with no charge to the patient. 2) To compensate the physician caring for these patients we would simply allow them to take their reasonable and customary charge, reduce it by 50%, and then submit this charge on their income tax as a tax credit. 3) No physician would be allowed to actually receive a tax refund beyond what they would have owed in tax, so the best a physician could do would be to pay no taxes on money generated elsewhere in the practice. It is often stated that patients show up for treatment sicker and further along in the course of their disease because they don't have insurance and thus wait to the last minute to present in the emergency room settings with more severe complicated illnesses that require more services and protracted stays with higher risks of complications.  By freeing the patients from the burden of worrying about how they will pay for this care, hopefully we will see the patients sooner and, in fact, make it less expensive for all parties concerned and have a higher quality of outcome for the patient.  It would be important to pick a threshold number at which all people earning under a certain level of income (who are not already eligible for Medicaid or Medicare) would be the only ones eligible for this program.  I submit that this level could be consistent with the current tax schedules for paying income tax.  Additionally, we could give an incentive to employers to provide insurance to employees tax free. The question of how this program would be administered is simple.  The physicians would continue to care for patients, submit their claims directly on their tax return.  They would be monitored by the Internal Revenue Service, and thus oversight would be criminal penalties should a physician falsify a claim.  Quality could be controlled by the fact that physicians already have peer review and oversight, both through their medical boards and hospital committees. Some would argue that this appears to be a tax break for physicians who don't need a tax break, as they are relatively high wage earners in this country.  I would submit that this, in fact, is not a tax break, but an actual small compensation for services that are currently being provided at no charge, and would continue to be provided at minimal charge, for amounts less that any program that could be created through government intervention. For argument's sake, let's just do the math.  There are approximately 300,000 physicians in this country, and the average income for a physician in this country is somewhere south of $150,000.  If we were to take all the physicians in the entire country and say that they all participate in this program and every physician provided enough free care to pay no income tax, we would then say that the country would loose the revenue of all 300,000 physicians' income tax amounting to 15 billion dollars.  If, however, we were to divide 15 billion dollars into 50 million patients, we see that the care being provided would be at the cost of approximately $300 per patient annually, far less than any program that could be administered by the government.  In reality, it is unlikely that all physicians would participate, so some revenue would still be generated for the Internal Revenue Service by physicians not participating in the program.  It is also likely that physicians who participate would more commonly overshoot the free care they were providing, and thus be giving care without compensation. Also, patients would gradually start to show up earlier and be less sick, so the actual charges generated by the physician would continue to go down. Thus, this program would have a built in quality improvement factor and an overall cost lowering feature. I have presented this idea to several political campaigns and to several organizations, both legal and medical. Unfortunately, most of the time it is met with comments such as "this does not create new jobs", or "this looks like a tax break for doctors".  As has been elucidated above, this is a sound program that would provide a service that would cost less than the government could ever dream of providing, continue our current system of health care which remains the best in the world, and remove the stigma that some feel is attached to an un-insured patient, thus resulting in overall better health for the American population as a whole. Everyone wants to think outside the box and wants to come up with the next new program, but sometimes the answer stares you right in the face.  I believe the time has come to do what is right and not what is politically enticing.  I would submit that this is the former, not the latter. Obtain Medical Specialty Own-Occupation Disability Insurance On-line