I am writing in response to your article "Political Actions Impact Practice" (Editor's Memo, November 2003). Initially, I do agree that all U.S. citizens, including all health care providers, need to understand politics and their impact on health care in the U.S. It is our duty to be educated and make educated decisions when we vote for our representation/leaders in the political arena.

However, I disagree with your statement that America doesn't collect enough taxes to have programs "we" want, that tax cuts are causing a "crisis", and that "wealthy" Americans have experienced a sharp drop in tax rates. First, who is included in "we" and what "crisis" are you referring to?

The top 50% of all wage earners in the U.S. pay 96.03% of taxes; the top 10% of wage earners pay 64.89% of taxes; and the top 5% of wage earners pay 53.25% of taxes. Less than $4 out of every $100 is paid by people in the bottom 50% of wage earners. The top 50% were couples filing jointly who earned $26,000 and up in 1999, and the top 1% earned $293,000 plus. The "wealthy" or top 1%, are paying 10 times more federal income taxes than the bottom 50%.

It has also been my observation that patients that receive Medicaid often receive better services than patients who have private insurance, and for free! I have not observed any type of crisis regarding the need for health care services for this population.

I also disagree with your claim that Reagan's economy/tax cuts didn't help and led to budget deficits. New research on President Reagan's "trickle down economics" support that lower taxes on the rich help the entire economy, while higher taxes on the rich often trickle down onto the backs of the middle class and the poor. Economist Charles Kadlec indicated that after income-tax rates were raised under President Clinton, after-tax incomes of the rich rose while middle class after-tax incomes shrank. This was due to business owners in America faced with higher taxes passing the cost onto others, such as workers by decreasing wages, or consumers by increasing prices. In addition, a study published by the Institute for Policy Innovation looked at the relationship between tax rates on the rich and income shares of the middle class over the 1970s, 1980s, and 1990s. In the 1990s, income tax on the wealthy increased and middle class income fell.

As a Nurse Practitioner in the U.S., I feel it is our responsibility to vote for political candidates that best represent our personal views.

We as health care providers also have an ethical duty to help our patients become as independent as possible, and not create more dependence on our federal and state government. If creating more dependence on Medicare, Medicaid, and Social Security is a goal, then we need to have socialized medicine in the U.S.[forms light horizontal]which is a very limiting system that most Americans would not stand for. If you are concerned about a class-based society, then socialized medicine would be your choice of care. Socialized medicine limits patients' access to services in a timely manner, eliminates choice of provider, eliminates elective health needs, and has many other consequences.

There are alternatives to the problem with cost of our health care system, including a private savings account for medical costs. I suggest that alternatives be researched before we just continue to raise taxes, give more handouts to the public, and cause more dependence on our government. It almost sounds like we are striving toward a communist way of living in the U.S., by giving our government more control[forms light horizontal]even over our health care decisions.

Pam Sisk, RN, MS, FNP, CNS, BC